Provider Demographics
NPI:1396710349
Name:STEWART, DIANE (DC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:UMHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6238 BUCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2757
Mailing Address - Country:US
Mailing Address - Phone:941-927-3734
Mailing Address - Fax:
Practice Address - Street 1:3982 BEE RIDGE RD STE H
Practice Address - Street 2:STE HH
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1211
Practice Address - Country:US
Practice Address - Phone:941-927-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 3307-L111N00000X
FLCH 9121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA473636Medicare ID - Type Unspecified
PAT30632Medicare UPIN
FLAB172Medicare UPIN