Provider Demographics
NPI:1336150663
Name:DELAROSA, DIANA (DC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DELAROSA
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:PO BOX 4098
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4098
Mailing Address - Country:US
Mailing Address - Phone:512-762-5880
Mailing Address - Fax:512-454-8577
Practice Address - Street 1:1929 PAYTON GIN RD
Practice Address - Street 2:STE E
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8501
Practice Address - Country:US
Practice Address - Phone:512-762-5880
Practice Address - Fax:512-582-8447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor