Provider Demographics
NPI:1770611451
Name:DINERMAN, JANE ELLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:DINERMAN
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 1:917 SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1303
Mailing Address - Country:US
Mailing Address - Phone:404-378-8978
Mailing Address - Fax:404-378-8978
Practice Address - Street 1:2545 LAWRENCEVILLE HWY
Practice Address - Street 2:100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3239
Practice Address - Country:US
Practice Address - Phone:404-378-6300
Practice Address - Fax:770-939-9353
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582244223OtherTAX ID NUMBER
GA35ZCFVLMedicare UPIN