Provider Demographics
NPI:1740350503
Name:EGAN, DIANE LOCKBERG (DC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LOCKBERG
Last Name:EGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:LOCKBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:859 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-975-7100
Mailing Address - Fax:978-975-7101
Practice Address - Street 1:859 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-975-7100
Practice Address - Fax:978-975-7101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T58293Medicare UPIN
MAY35616Medicare PIN