Provider Demographics
NPI:1982122875
Name:DIETRICK, JAMES (DC, CCEP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:DIETRICK
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GREGORY LN STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2771
Mailing Address - Country:US
Mailing Address - Phone:925-395-0252
Mailing Address - Fax:
Practice Address - Street 1:670 GREGORY LN STE C
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2771
Practice Address - Country:US
Practice Address - Phone:925-395-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty