Provider Demographics
NPI:1548282742
Name:COLE, DIANA (DC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:COLE
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 1:30 STONECREST CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8128
Mailing Address - Country:US
Mailing Address - Phone:502-647-4600
Mailing Address - Fax:502-647-4607
Practice Address - Street 1:30 STONECREST CT
Practice Address - Street 2:STE 102
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8128
Practice Address - Country:US
Practice Address - Phone:502-647-4600
Practice Address - Fax:502-647-4607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400023027Medicare PIN
KY00344001Medicare PIN
KY6525140001Medicare NSC