Provider Demographics
NPI:1932107406
Name:DIMOND, JOHN R (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DIMOND
Suffix:
Gender:M
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:OLD RTE 66 & HILL STREET
Mailing Address - Street 2:BOX 200
Mailing Address - City:MC GRANN
Mailing Address - State:PA
Mailing Address - Zip Code:16236-0200
Mailing Address - Country:US
Mailing Address - Phone:724-763-8000
Mailing Address - Fax:724-763-8007
Practice Address - Street 1:OLD RTE 66 & HILL STREET
Practice Address - Street 2:# 200
Practice Address - City:MC GRANN
Practice Address - State:PA
Practice Address - Zip Code:16236-0200
Practice Address - Country:US
Practice Address - Phone:724-763-8000
Practice Address - Fax:724-763-8007
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001391L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006346830002Medicaid
PAT28714Medicare UPIN
PA107190Medicare PIN