Provider Demographics
NPI:1982780565
Name:STONE, DIANNA RAE (BA DC)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:RAE
Last Name:STONE
Suffix:
Gender:F
Credentials:BA DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 PARK BLVD
Mailing Address - Street 2:#4
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-287-6191
Mailing Address - Fax:510-601-7110
Practice Address - Street 1:3923 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4546
Practice Address - Country:US
Practice Address - Phone:510-287-6191
Practice Address - Fax:510-601-7110
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28087111N00000X
CODC5224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor