Healthcare Provider Details

I. General information

NPI: 1497820096
Provider Name (Legal Business Name): MICHAEL ROBERT DIAMOND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8632 S SEPULVEDA BLVD SUITE 101
WESTCHESTER CA
90045-4013
US

IV. Provider business mailing address

8632 S SEPULVEDA BLVD SUITE 101
WESTCHESTER CA
90045-4013
US

V. Phone/Fax

Practice location:
  • Phone: 310-348-8298
  • Fax: 310-348-8299
Mailing address:
  • Phone: 310-348-8298
  • Fax: 310-348-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: