Provider Demographics
NPI:1851645741
Name:BENEDICT, SUSAN EMILY
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EMILY
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:EMILY
Other - Last Name:BENEDICT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:133 S HUDSON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2614
Mailing Address - Country:US
Mailing Address - Phone:626-398-1394
Mailing Address - Fax:626-449-5515
Practice Address - Street 1:133 S HUDSON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2614
Practice Address - Country:US
Practice Address - Phone:626-398-1394
Practice Address - Fax:626-449-5515
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20510111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition