Provider Demographics
NPI:1588711923
Name:GOSS, SUZANNE L (DC)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:L
Last Name:GOSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2128
Mailing Address - Country:US
Mailing Address - Phone:215-757-0785
Mailing Address - Fax:
Practice Address - Street 1:148 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2835
Practice Address - Country:US
Practice Address - Phone:215-741-1300
Practice Address - Fax:215-741-9311
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003362L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC003362LOtherCHIROPRACTIC LICENSE
PADC003362LOtherCHIROPRACTIC LICENSE
PA716715Medicare ID - Type Unspecified