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General NPI Number Information
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NPI Number | 1770611451
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Entity Type | Individual
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Provider Name | JANE ELLEN DINERMAN D.C.
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 2545 LAWRENCEVILLE HWY 100
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City | DECATUR
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State | GA
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Zip | 30033-3239
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Country | US
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Telephone | 404-378-6300
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Fax | 770-939-9353
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Provider Business Mailing Address
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Address Line | 917 SCOTT BLVD
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City | DECATUR
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State | GA
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Zip | 30030-1303
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Country | US
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Telephone | 404-378-8978
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Fax | 404-378-8978
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 002592
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License Number State | GA
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