Provider Demographics
NPI:1538866470
Name:MEJIA, DIANNA MICHELLE (DC)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:MICHELLE
Last Name:MEJIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:MICHELLE
Other - Last Name:AMARAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 MOUNT ORD LN
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2241
Mailing Address - Country:US
Mailing Address - Phone:209-628-9974
Mailing Address - Fax:
Practice Address - Street 1:9217 W US HIGHWAY 290 STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-7818
Practice Address - Country:US
Practice Address - Phone:512-222-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor