Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC171000 | CA |
NPI | 1265464853 |
---|---|
Provider Name | Joseph Diquattro |
First Address | Palm Springs, CA 92262-7964 |
Second Address | Palm Springs, CA 92262-7964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 18/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0171000 | MEDICARE PTAN (01) | CA |
DC17100 | DC LICENSE (01) | CA |
T82642 | (02) | CA |