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NPI Code Detail

MEDICARE: DIANE CHRISTOPHERSON D.C.

MEDICARE:   DIANE  CHRISTOPHERSON  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
1111NX0800XOrthopedic ChiropractorDC18358CA
2111N00000XChiropractor18358CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DC0183580OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1164453460
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE CHRISTOPHERSON D.C.
Provider Business Mailing Address
First Line : 1278 GLENNEYRE ST STE 233
Second Line :
City : LAGUNA BEACH
State : CA
Zip : 92651-3103
Country : US
Telephone Number : 949-497-3212
Fax Number : 949-497-1564
Provider Business Practice Location Address
First Line : 1502 N. COAST HIGHWAY
Second Line :
City : LAGUNA BEACH
State : CA
Zip : 92651-3103
Country : US
Telephone Number : 949-497-3212
Fax Number : 949-497-1564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 06/09/2015

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