Provider Demographics
NPI:1285748145
Name:DIAMOND CHIROPRACTIC, PC
Entity type:Organization
Organization Name:DIAMOND CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-448-7500
Mailing Address - Street 1:475 SAINT MARKS PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2408
Mailing Address - Country:US
Mailing Address - Phone:718-448-7500
Mailing Address - Fax:718-448-7530
Practice Address - Street 1:475 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2408
Practice Address - Country:US
Practice Address - Phone:718-448-7500
Practice Address - Fax:718-448-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5C061Medicare PIN
NYXAWNF1Medicare PIN