Provider Demographics
NPI:1306282751
Name:DIETZEN, FREDRICK (DC)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:
Last Name:DIETZEN
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 1:391 TAYLOR BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2294
Mailing Address - Country:US
Mailing Address - Phone:925-523-1022
Mailing Address - Fax:
Practice Address - Street 1:391 TAYLOR BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2257
Practice Address - Country:US
Practice Address - Phone:925-523-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor