Provider Demographics
NPI:1700940574
Name:BISCHOF, DIANN ELAINE (DC)
Entity type:Individual
Prefix:DR
First Name:DIANN
Middle Name:ELAINE
Last Name:BISCHOF
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 1:220 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1522
Mailing Address - Country:US
Mailing Address - Phone:636-271-3600
Mailing Address - Fax:
Practice Address - Street 1:220 N COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1522
Practice Address - Country:US
Practice Address - Phone:636-271-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004026180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO197367OtherBLUE CROSS BLUE SHIELD
MDVO3836Medicare UPIN