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General NPI Number Information
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NPI Number | 1649243155
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Entity Type | Organization
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Legal Business Name | DIANE BELLWOOD, INC
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8645 HAVEN AVE SUITE 700
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4818
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Country | US
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Telephone | 909-941-0633
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Fax | 909-945-5372
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Provider Business Mailing Address
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Address Line | 646 W EDNA PL
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City | COVINA
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State | CA
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Zip | 91722-3220
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Country | US
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Telephone | 626-622-9658
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Fax | 626-858-0456
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE S. BELLWOOD
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Credential | D.C.
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Telephone | 626-622-9658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 18328
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License Number State | CA
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