Healthcare Provider Details

I. General information

NPI: 1366434714
Provider Name (Legal Business Name): DIANE J NAVARRO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANE J RUSNAK

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SCOTCH RD
EWING NJ
08628-2511
US

IV. Provider business mailing address

201 SCOTCH RD
EWING NJ
08628-2511
US

V. Phone/Fax

Practice location:
  • Phone: 609-530-1400
  • Fax: 609-530-1400
Mailing address:
  • Phone: 609-530-1400
  • Fax: 609-530-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00318000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC002954L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: