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General NPI Number Information
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NPI Number | 1710150107
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Entity Type | Organization
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Legal Business Name | DIANE L MICHAELS DC PA
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 501 VILLAGE GREEN PKWY SUITE 15
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City | BRADENTON
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State | FL
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Zip | 34209-3404
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Country | US
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Telephone | 941-761-0210
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Fax | 941-795-0708
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Provider Business Mailing Address
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Address Line | 501 VILLAGE GREEN PKWY SUITE 15
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City | BRADENTON
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State | FL
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Zip | 34209-3404
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Country | US
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Telephone | 941-761-0210
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Fax | 941-795-0708
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Authorized Official
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Title or Position | DR. DIANE L. MICHAELS
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Name | DR. DIANE LEE MICHAELS
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Credential | D.C.
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Telephone | 941-761-0210
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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 | CH0006891
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License Number State | FL
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