Provider Demographics
NPI:1093099087
Name:SUZUKI, CHERI (LAC)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:SUZUKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1234
Mailing Address - Country:US
Mailing Address - Phone:207-751-7987
Mailing Address - Fax:
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1234
Practice Address - Country:US
Practice Address - Phone:207-751-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC331171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist