Healthcare Provider Details

I. General information

NPI: 1689972671
Provider Name (Legal Business Name): CHERYL LYNN DIETRICK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 BLUE RAVINE RD STE 245
FOLSOM CA
95630-4767
US

IV. Provider business mailing address

193 BLUE RAVINE RD STE 245
FOLSOM CA
95630-4767
US

V. Phone/Fax

Practice location:
  • Phone: 916-989-1014
  • Fax: 916-989-1461
Mailing address:
  • Phone: 916-989-1014
  • Fax: 916-989-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number19098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: