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1346320736 NPI number — DIANA LYNN SRDICH D.C.

NPI Number: 1346320736
Health Care Provider/Practitioner: DIANA LYNN SRDICH D.C.

Information about “1346320736” NPI (DIANA LYNN SRDICH D.C.) exists in 1346320736 in HTML format HTML  |  1346320736 in plain Text format TXT  |  1346320736 in PDF (Portable Document Format) PDF  |  1346320736 in an XML format XML  formats.

NPI Number : 1346320736 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346320736",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SRDICH",
    "FirstName": "DIANA",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILLOUGHBY",
    "OtherFirstName": "DIANA",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "8765 W KELTON LN",
    "SecondLineMailingAddress": "BLDG B-4, SUITE 150",
    "MailingAddressCityName": "PEORIA",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85382-3584",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "623-979-7100",
    "MailingAddressFaxNumber": "623-979-3577",
    "FirstLinePracticeLocationAddress": "8765 W KELTON LN",
    "SecondLinePracticeLocationAddress": "BLDG B-4, SUITE 150",
    "PracticeLocationAddressCityName": "PEORIA",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85382-3584",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "623-979-7100",
    "PracticeLocationAddressFaxNumber": "623-979-3577",
    "EnumerationDate": "10/17/2006",
    "LastUpdateDate": "07/19/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111NX0800X",
        "TaxonomyName": "Orthopedic Chiropractor",
        "LicenseNumber": "5254",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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