Provider Demographics
NPI:1003957499
Name:STRADER, SUSAN RUFENA (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RUFENA
Last Name:STRADER
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 1:5822 S SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2737
Mailing Address - Country:US
Mailing Address - Phone:720-244-8738
Mailing Address - Fax:
Practice Address - Street 1:5822 S SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2737
Practice Address - Country:US
Practice Address - Phone:720-244-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU94944Medicare UPIN
COC494328Medicare PIN