Provider Demographics
NPI:1750406559
Name:GAILES, DIANA B (DC)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:B
Last Name:GAILES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:GAILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:49 LAKE AVE STE 1E
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4519
Mailing Address - Country:US
Mailing Address - Phone:203-983-5426
Mailing Address - Fax:203-622-8228
Practice Address - Street 1:49 LAKE AVE STE 1E
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4519
Practice Address - Country:US
Practice Address - Phone:203-983-5426
Practice Address - Fax:203-622-8228
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001928111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001928OtherCT LICENSE
RIDCP00461OtherRI LICENSE