Provider Demographics
NPI:1063624070
Name:SEXTON, DIANE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:SEXTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5524
Mailing Address - Country:US
Mailing Address - Phone:410-583-2182
Mailing Address - Fax:
Practice Address - Street 1:121 W SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5524
Practice Address - Country:US
Practice Address - Phone:410-583-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1180PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59606Medicare UPIN
MDM760Medicare ID - Type Unspecified