Provider Demographics
NPI:1588822217
Name:VLASUK, SUSAN L (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:VLASUK
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 1:875 140TH AVE NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3400
Mailing Address - Country:US
Mailing Address - Phone:425-451-1199
Mailing Address - Fax:425-454-3953
Practice Address - Street 1:875 140TH AVE NE
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3400
Practice Address - Country:US
Practice Address - Phone:425-451-1199
Practice Address - Fax:425-454-3953
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000826111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology