MEDICARE: DR. DIANE C VAN LEEUWEN D.C.

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	111N00000X	Chiropractor	24017	CA

General Provider Information

NPI Number	:	1144462946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE C VAN LEEUWEN D.C.

Provider Business Mailing Address
First Line	:	275 CENTENNIAL WAY
Second Line	:	SUITE 207
City	:	TUSTIN
State	:	CA
Zip	:	92780-3708
Country	:	US
Telephone Number	:	949-400-4438
Fax Number	:	714-665-4245

Provider Business Practice Location Address
First Line	:	275 CENTENNIAL WAY
Second Line	:	SUITE 207
City	:	TUSTIN
State	:	CA
Zip	:	92780-3708
Country	:	US
Telephone Number	:	949-400-4438
Fax Number	:	714-665-4245

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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