Provider Demographics
NPI:1992705461
Name:COFFEY, SUZANNE ALICE (DC)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ALICE
Last Name:COFFEY
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 1:689 BERKMAR CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1464
Mailing Address - Country:US
Mailing Address - Phone:434-975-1994
Mailing Address - Fax:434-975-1988
Practice Address - Street 1:689 BERKMAR CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1464
Practice Address - Country:US
Practice Address - Phone:434-975-1994
Practice Address - Fax:434-975-1988
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
049562OtherANTHEM GROUP
54-149-3132OtherFEDERAL TAX ID
049563OtherANTHEM PROVIDER
049562OtherANTHEM GROUP
049563OtherANTHEM PROVIDER