Healthcare Provider Details

I. General information

NPI: 1053309567
Provider Name (Legal Business Name): PETER E DIAMOND DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 N FEDERAL HWY
FORT LAUDERDALE FL
33304
US

IV. Provider business mailing address

906 N FEDERAL HWY
FORT LAUDERDALE FL
33304-2707
US

V. Phone/Fax

Practice location:
  • Phone: 954-371-0460
  • Fax:
Mailing address:
  • Phone: 954-533-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: