Provider Demographics
NPI:1104807494
Name:MICHAELS, DIANE LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LEE
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:LEE
Other - Last Name:HOROWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:501 VILLAGE GREEN PKWY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3404
Mailing Address - Country:US
Mailing Address - Phone:941-761-0210
Mailing Address - Fax:941-795-0708
Practice Address - Street 1:501 VILLAGE GREEN PKWY
Practice Address - Street 2:SUITE 15
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3404
Practice Address - Country:US
Practice Address - Phone:941-761-0210
Practice Address - Fax:941-795-0708
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10715738OtherCAQH
FL10715738OtherCAQH
FLU60348Medicare UPIN
FL200496157OtherTIN