MEDICARE: DR. DIANE CHRISTINE GERKEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	024079	CA

General Provider Information

NPI Number	:	1023132255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE CHRISTINE GERKEN D.C.

Provider Business Mailing Address
First Line	:	88 E BONITA RD STE E
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-3057
Country	:	US
Telephone Number	:	619-422-3088
Fax Number	:	619-422-3988

Provider Business Practice Location Address
First Line	:	88 E BONITA RD STE E
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-3057
Country	:	US
Telephone Number	:	619-422-3088
Fax Number	:	619-422-3988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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