Provider Demographics
NPI:1447308754
Name:DIMINO, JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:DIMINO
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 1:1721 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2644
Mailing Address - Country:US
Mailing Address - Phone:563-242-5515
Mailing Address - Fax:563-242-0765
Practice Address - Street 1:1721 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2644
Practice Address - Country:US
Practice Address - Phone:563-242-5515
Practice Address - Fax:563-242-0765
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA250354OtherMIDLANDS CHOICE
IAP0028921OtherRR MEDICARE
IA13244OtherWELLMARK BC BS
IA0485524Medicaid
IAI17279Medicare ID - Type Unspecified
IA13244OtherWELLMARK BC BS