Provider Demographics
NPI:1093866345
Name:DARDEAU, SUZANNE PATRICIA (DC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:PATRICIA
Last Name:DARDEAU
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:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-0278
Mailing Address - Country:US
Mailing Address - Phone:337-886-9703
Mailing Address - Fax:337-886-0658
Practice Address - Street 1:102 GREG ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6248
Practice Address - Country:US
Practice Address - Phone:337-886-9703
Practice Address - Fax:337-886-0658
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1956147Medicaid
LA1956147Medicaid
LA721248718OtherTIN
LA1956147Medicaid