Provider Demographics
NPI:1598849002
Name:ROBERTS, SUZANNE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 E BIDWELL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6430
Mailing Address - Country:US
Mailing Address - Phone:916-983-7771
Mailing Address - Fax:916-983-7996
Practice Address - Street 1:2690 E BIDWELL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6430
Practice Address - Country:US
Practice Address - Phone:916-983-7771
Practice Address - Fax:916-983-7996
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA495402Medicare UPIN
CADC0288461Medicare ID - Type Unspecified