Provider Demographics
NPI:1811083231
Name:MAGLENTE, DIREN S (DC)
Entity type:Individual
Prefix:
First Name:DIREN
Middle Name:S
Last Name:MAGLENTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 SE 165TH AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4323
Mailing Address - Country:US
Mailing Address - Phone:360-798-4175
Mailing Address - Fax:888-461-3735
Practice Address - Street 1:2415 SE 165TH AVE
Practice Address - Street 2:STE 105
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4323
Practice Address - Country:US
Practice Address - Phone:360-798-4175
Practice Address - Fax:888-461-3735
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC0000847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI101258Medicare PIN
HIU02199Medicare UPIN