Provider Demographics
NPI:1548454531
Name:SUYAK CHIROPRACTIC CENTER PROFESSIONAL LLC
Entity type:Organization
Organization Name:SUYAK CHIROPRACTIC CENTER PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUYAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:303-421-1910
Mailing Address - Street 1:9264 W 91ST PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4428
Mailing Address - Country:US
Mailing Address - Phone:303-421-1910
Mailing Address - Fax:
Practice Address - Street 1:9264 W 91ST PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4428
Practice Address - Country:US
Practice Address - Phone:303-421-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-01
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC475698Medicare PIN