# DR. ANTON N DIETZEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1063659076
- **Gender:** Man
- **Credential:** M.D., D.C.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 038011314 | IL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 036149703 | IL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | D0089692 | MD | — |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | 036149703 | IL | Yes |
| 208600000X | Surgery Physician | 125.069633 | IL | — |

## Other

- **Enumeration date:** 01/13/2009
- **Last updated:** 09/12/2023