Provider Demographics
NPI:1316563158
Name:HASSAN, DIANA (DC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 VILLAGE CENTER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-4526
Mailing Address - Country:US
Mailing Address - Phone:630-920-4670
Mailing Address - Fax:
Practice Address - Street 1:1255 S STATE ST UNIT 6
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1928
Practice Address - Country:US
Practice Address - Phone:312-248-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor