Healthcare Provider Details

I. General information

NPI: 1508993114
Provider Name (Legal Business Name): STEPHEN DIAMANTIDES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5358 SPRING HILL DR
SPRING HILL FL
34606-4562
US

IV. Provider business mailing address

15215 CORTEZ BLVD
BROOKSVILLE FL
34613-6072
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-7312
  • Fax: 352-686-8240
Mailing address:
  • Phone: 352-799-0046
  • Fax: 352-799-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: