Healthcare Provider Details

I. General information

NPI: 1245958073
Provider Name (Legal Business Name): DIEP NEURO SPINE CHIROPRACTIC INSTITUTE, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S GARFIELD AVE STE 101
ALHAMBRA CA
91801-3876
US

IV. Provider business mailing address

430 S GARFIELD AVE STE 101
ALHAMBRA CA
91801-3876
US

V. Phone/Fax

Practice location:
  • Phone: 626-575-1211
  • Fax: 626-575-1511
Mailing address:
  • Phone: 626-575-1211
  • Fax: 626-575-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. DAN DIEP
Title or Position: PRESIDENT
Credential: D.C.
Phone: 626-757-9458