Provider Demographics
NPI:1902000235
Name:PHAN, DIANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 SEVEN CORNERS PL STE K
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2011
Mailing Address - Country:US
Mailing Address - Phone:703-538-8881
Mailing Address - Fax:
Practice Address - Street 1:6408 SEVEN CORNERS PL STE K
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2011
Practice Address - Country:US
Practice Address - Phone:703-538-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG380-0001OtherCAREFIRST
VA7046200OtherAETNA
VA1027672OtherASHN
VA3908975OtherAETNA
VA461747OtherTRIGON
VA461747OtherTRIGON