Provider Demographics
NPI:1538245667
Name:MILLIGAN, DIANE CHRISTINE (DC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CHRISTINE
Last Name:MILLIGAN
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 1:1949 LANSING AVE STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2190
Mailing Address - Country:US
Mailing Address - Phone:517-812-7559
Mailing Address - Fax:517-962-2466
Practice Address - Street 1:1949 LANSING AVE
Practice Address - Street 2:STE B
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2190
Practice Address - Country:US
Practice Address - Phone:517-885-4437
Practice Address - Fax:517-962-2466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2745860Medicaid
MI2745860Medicaid