Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 5254 | AZ |
NPI | 1346320736 |
---|---|
Provider Name | Diana Lynn Srdich |
First Address | Peoria, AZ 85382-3584 |
Second Address | Peoria, AZ 85382-3584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 19/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1Z4643 | HEALTH NET (01) | AZ |
350043946 | RR MEDICARE (01) | AZ |
AZ0248500 | BLUE CROSS/ BLUE SHIELD (01) | AZ |
U19831 | (02) | AZ |