MEDICARE: JOSE DIAZ DN

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	172P00000X	Naprapath	181000384	IL
2	172P00000X	Naprapath	01004	NM

General Provider Information

NPI Number	:	1053739094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE DIAZ DN

Provider Business Mailing Address
First Line	:	3746 W 62ND PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4019
Country	:	US
Telephone Number	:	773-294-6899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4001
Country	:	US
Telephone Number	:	773-294-6899
Fax Number	:

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

Provider Enumeration Date	:	04/06/2014
Last Update Date	:	02/08/2016

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Directions to “ JOSE DIAZ DN” Practice Location

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