Provider Demographics
NPI:1649243155
Name:DIANE BELLWOOD, INC
Entity type:Organization
Organization Name:DIANE BELLWOOD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-622-9658
Mailing Address - Street 1:646 W EDNA PL
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3220
Mailing Address - Country:US
Mailing Address - Phone:626-622-9658
Mailing Address - Fax:626-858-0456
Practice Address - Street 1:8645 HAVEN AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4818
Practice Address - Country:US
Practice Address - Phone:909-941-0633
Practice Address - Fax:909-945-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty