Provider Demographics
NPI:1063694065
Name:ERIC R. DIEFFENBAUGHER DC
Entity type:Organization
Organization Name:ERIC R. DIEFFENBAUGHER DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIEFFENBAUGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-874-2849
Mailing Address - Street 1:5957 BOYMEL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5633
Mailing Address - Country:US
Mailing Address - Phone:513-874-2849
Mailing Address - Fax:513-874-4235
Practice Address - Street 1:5957 BOYMEL DR STE 4
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5633
Practice Address - Country:US
Practice Address - Phone:513-874-2849
Practice Address - Fax:513-874-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4084441OtherRENDERING PROVIDER ID
OH1467492272OtherINDIVIDUAL NPI
OH4084441OtherRENDERING PROVIDER ID
OH9325251Medicare PIN