Provider Demographics
NPI:1144426206
Name:BELLIVEAU, NANCY SUTHERLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SUTHERLAND
Last Name:BELLIVEAU
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 1:8157 BRENTWOOD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1166
Mailing Address - Country:US
Mailing Address - Phone:925-516-1395
Mailing Address - Fax:
Practice Address - Street 1:8157 BRENTWOOD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1166
Practice Address - Country:US
Practice Address - Phone:925-516-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA209141Medicare PIN