Provider Demographics
NPI:1548446388
Name:JURGENSEN, DIANNE (DC)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:JURGENSEN
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 1:16575 LOS GATOS ALMADEN RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3582
Mailing Address - Country:US
Mailing Address - Phone:408-358-2434
Mailing Address - Fax:408-358-1365
Practice Address - Street 1:16575 LOS GATOS ALMADEN RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3582
Practice Address - Country:US
Practice Address - Phone:408-358-2434
Practice Address - Fax:408-358-1365
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor