Provider Demographics
NPI:1326567330
Name:SUESS FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SUESS FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-972-6121
Mailing Address - Street 1:22 WYCKOFF AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1718
Mailing Address - Country:US
Mailing Address - Phone:201-972-6121
Mailing Address - Fax:201-447-0827
Practice Address - Street 1:22 WYCKOFF AVE STE 1
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1718
Practice Address - Country:US
Practice Address - Phone:201-972-6121
Practice Address - Fax:201-447-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00738400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty