Provider Demographics
NPI:1205933306
Name:DIANNE L. COMO, DC, PA
Entity type:Organization
Organization Name:DIANNE L. COMO, DC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-595-9096
Mailing Address - Street 1:669 WINNETKA AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4574
Mailing Address - Country:US
Mailing Address - Phone:763-595-9096
Mailing Address - Fax:763-595-0291
Practice Address - Street 1:669 WINNETKA AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4574
Practice Address - Country:US
Practice Address - Phone:763-595-9096
Practice Address - Fax:763-595-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3191261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN55F12COOtherBCBS
MN889027700Medicaid
MN55F12COOtherBCBS
MN53213Medicare UPIN