Healthcare Provider Details

I. General information

NPI: 1134856743
Provider Name (Legal Business Name): LORNA H DIAZ-OLIVERAS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3652 CHAMBLEE DUNWOODY RD STE 1
CHAMBLEE GA
30341-2120
US

IV. Provider business mailing address

3652 CHAMBLEE DUNWOODY RD STE 1
CHAMBLEE GA
30341-2120
US

V. Phone/Fax

Practice location:
  • Phone: 770-452-2955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010825
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: