Provider Demographics
NPI:1053592188
Name:DIANICH, KARI L (DC)
Entity type:Individual
Prefix:DR
First Name:KARI
Middle Name:L
Last Name:DIANICH
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 1:235 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3412
Mailing Address - Country:US
Mailing Address - Phone:404-371-8595
Mailing Address - Fax:
Practice Address - Street 1:235 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3412
Practice Address - Country:US
Practice Address - Phone:404-371-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDWBMedicare UPIN