Healthcare Provider Details

I. General information

NPI: 1780575076
Provider Name (Legal Business Name): DIANA ROSE MASTELLER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E 3RD ST
NESCOPECK PA
18635-1407
US

IV. Provider business mailing address

820 E 3RD ST
NESCOPECK PA
18635-1407
US

V. Phone/Fax

Practice location:
  • Phone: 570-759-7009
  • Fax: 570-759-8099
Mailing address:
  • Phone: 570-759-7009
  • Fax: 570-759-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC012049
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: