Provider Demographics
NPI:1790382828
Name:DILLER, ANTONIA FORSYTH (DC)
Entity type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:FORSYTH
Last Name:DILLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ANTONIA
Other - Middle Name:JULIETTE
Other - Last Name:FORSYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1775 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1338
Mailing Address - Country:US
Mailing Address - Phone:707-616-6156
Mailing Address - Fax:
Practice Address - Street 1:1775 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1338
Practice Address - Country:US
Practice Address - Phone:707-616-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor