MEDICARE: DR. GARY WAYNE DIEKMANN DC

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	1048	AZ

General Provider Information

NPI Number	:	1972781979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY WAYNE DIEKMANN DC

Provider Business Mailing Address
First Line	:	1802 E THOMAS RD
Second Line	:	SUITE 16
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	602-265-6893
Fax Number	:	602-631-9362

Provider Business Practice Location Address
First Line	:	1802 E THOMAS RD
Second Line	:	SUITE 16
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	602-265-6893
Fax Number	:	602-631-9362

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

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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