MEDICARE: JOHN R DIMOND 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	DC001391L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932107406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R DIMOND D.C.

Provider Business Mailing Address
First Line	:	OLD RTE 66 & HILL STREET
Second Line	:	BOX 200
City	:	MC GRANN
State	:	PA
Zip	:	16236-0200
Country	:	US
Telephone Number	:	724-763-8000
Fax Number	:	724-763-8007

Provider Business Practice Location Address
First Line	:	OLD RTE 66 & HILL STREET
Second Line	:	# 200
City	:	MC GRANN
State	:	PA
Zip	:	16236-0200
Country	:	US
Telephone Number	:	724-763-8000
Fax Number	:	724-763-8007

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/09/2008

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Directions to “ JOHN R DIMOND D.C.” Practice Location

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