MEDICARE: DR. DIANN KALE DC, FICCI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	CH00001133	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	G000315137	OTHER	WA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74999	OTHER	WA	L & I
2	0911462790-00	OTHER	WA	MEDICADE

General Provider Information

NPI Number	:	1023119328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANN KALE DC, FICCI

Provider Business Mailing Address
First Line	:	100 VALLEY MALL PKWY
Second Line	:	SUITE 5
City	:	EAST WENATCHEE
State	:	WA
Zip	:	98802-5348
Country	:	US
Telephone Number	:	509-884-2339
Fax Number	:	509-884-4720

Provider Business Practice Location Address
First Line	:	100 VALLEY MALL PARKWAY
Second Line	:	SUITE 5
City	:	EAST WENATCHEE
State	:	WA
Zip	:	98802-5348
Country	:	US
Telephone Number	:	509-884-2339
Fax Number	:	509-884-4720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	10/17/2011

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