Provider Demographics
NPI:1881805133
Name:MICHAEL, DIANE (DC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 MARKET ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5311
Mailing Address - Country:US
Mailing Address - Phone:415-982-2273
Mailing Address - Fax:415-982-2282
Practice Address - Street 1:388 MARKET ST
Practice Address - Street 2:STE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5311
Practice Address - Country:US
Practice Address - Phone:415-982-2273
Practice Address - Fax:415-982-2282
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0257530Medicare ID - Type Unspecified