Provider Demographics
NPI:1154597789
Name:DIBLASI, JOHN PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:DIBLASI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 VETERANS PKWY
Mailing Address - Street 2:STE 2
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6223
Mailing Address - Country:US
Mailing Address - Phone:706-324-5755
Mailing Address - Fax:
Practice Address - Street 1:6100 VETERANS PKWY
Practice Address - Street 2:STE 2
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6223
Practice Address - Country:US
Practice Address - Phone:706-324-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor