Healthcare Provider Details

I. General information

NPI: 1992719629
Provider Name (Legal Business Name): RYAN M. DIEBOLD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9004 W 88TH AVE
WESTMINSTER CO
80005-1586
US

IV. Provider business mailing address

9004 W 88TH AVE
WESTMINSTER CO
80005-1586
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-5710
  • Fax: 303-456-5760
Mailing address:
  • Phone: 303-456-5710
  • Fax: 303-456-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5442
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: