Healthcare Provider Details

I. General information

NPI: 1972215150
Provider Name (Legal Business Name): JAILINE LOPEZ DIAZ DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 KNIGHTSBRIDGE BLVD STE C
COLUMBUS OH
43214-2300
US

IV. Provider business mailing address

4830 KNIGHTSBRIDGE BLVD STE C
COLUMBUS OH
43214-2300
US

V. Phone/Fax

Practice location:
  • Phone: 614-944-8888
  • Fax:
Mailing address:
  • Phone: 787-559-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05273
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: