Provider Demographics
NPI:1962715888
Name:LOUDENBECK, DIANNA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:LYNN
Last Name:LOUDENBECK
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 1:595 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1301
Mailing Address - Country:US
Mailing Address - Phone:541-266-7543
Mailing Address - Fax:541-269-9408
Practice Address - Street 1:595 S 7TH ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1301
Practice Address - Country:US
Practice Address - Phone:541-266-7543
Practice Address - Fax:541-269-9408
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor