Provider Demographics
NPI:1043258601
Name:DIBLASE, FRANK PETER (DC)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:PETER
Last Name:DIBLASE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 N VICTORIA PARK RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2418
Mailing Address - Country:US
Mailing Address - Phone:954-696-8141
Mailing Address - Fax:954-779-3457
Practice Address - Street 1:1753 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3601
Practice Address - Country:US
Practice Address - Phone:954-696-8141
Practice Address - Fax:954-832-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97645Medicare UPIN
FL89146Medicare ID - Type Unspecified