Diana Lynn Srdich, D.C.

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

5254 Issued in AZ

Practice address

8765 W Kelton LN
BLDG B-4, Suite 150
Peoria, AZ 85382-3584

Phone

(623) 979-7100

Fax

(623) 979-3577

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Diana Lynn Willoughby Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1346320736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8765 W KELTON LN",
            "address_2": "BLDG B-4, SUITE 150",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853823584",
            "telephone_number": "623-979-7100",
            "fax_number": "623-979-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8765 W KELTON LN",
            "address_2": "BLDG B-4, SUITE 150",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853823584",
            "telephone_number": "623-979-7100",
            "fax_number": "623-979-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRDICH",
        "first_name": "DIANA",
        "middle_name": "LYNN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "AZ",
            "license": "5254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "350043946",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "1Z4643",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "AZ0248500",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "WILLOUGHBY",
            "middle_name": "LYNN",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Orthopedic Chiropractor in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Orthopedic Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.