Provider Demographics
NPI:1922242973
Name:DIASO CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DIASO CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DIASO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:805-927-1055
Mailing Address - Street 1:29369 AUBERRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PRATHER
Mailing Address - State:CA
Mailing Address - Zip Code:93651-9784
Mailing Address - Country:US
Mailing Address - Phone:559-855-8445
Mailing Address - Fax:559-855-8440
Practice Address - Street 1:4070 WEST ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428
Practice Address - Country:US
Practice Address - Phone:805-927-1055
Practice Address - Fax:805-927-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU26594Medicare UPIN