Provider Demographics
NPI:1841493707
Name:DIAZ, JAMES A (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-0307
Mailing Address - Country:US
Mailing Address - Phone:707-462-7093
Mailing Address - Fax:888-502-0723
Practice Address - Street 1:486 N STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4422
Practice Address - Country:US
Practice Address - Phone:707-462-7093
Practice Address - Fax:888-502-0723
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU44176Medicare UPIN
CADC0219441Medicare PIN