Provider Demographics
NPI:1972677011
Name:DICEGLIE, TAMMY M (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:M
Last Name:DICEGLIE
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 1:1640 W SHAW AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3506
Mailing Address - Country:US
Mailing Address - Phone:559-226-2185
Mailing Address - Fax:559-225-2952
Practice Address - Street 1:1640 W. SHAW AVE.
Practice Address - Street 2:SUITE 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711
Practice Address - Country:US
Practice Address - Phone:559-226-2185
Practice Address - Fax:559-225-2952
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU20470Medicare UPIN
CADC0209540Medicare PIN