Provider Demographics
NPI:1427500081
Name:MATSON, DIANA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIE
Last Name:MATSON
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 1:5170 GOLDEN FOOTHILL PKWY STE 127
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9608
Mailing Address - Country:US
Mailing Address - Phone:916-467-8387
Mailing Address - Fax:
Practice Address - Street 1:5170 GOLDEN FOOTHILL PKWY STE 127
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9608
Practice Address - Country:US
Practice Address - Phone:916-467-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60756698111N00000X
CA33733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor