Provider Demographics
NPI:1104544741
Name:DI DIEGO, BRIAN PETER (ND)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PETER
Last Name:DI DIEGO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47544 105TH ST
Mailing Address - Street 2:
Mailing Address - City:TRUMAN
Mailing Address - State:MN
Mailing Address - Zip Code:56088-2172
Mailing Address - Country:US
Mailing Address - Phone:520-227-1505
Mailing Address - Fax:
Practice Address - Street 1:105 CENTER AVE N
Practice Address - Street 2:
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1429
Practice Address - Country:US
Practice Address - Phone:507-412-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath