Provider Demographics
NPI:1386674190
Name:SILVEIRA, SUSANA DENISE (DC)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:DENISE
Last Name:SILVEIRA
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 1:528 E BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-2339
Mailing Address - Country:US
Mailing Address - Phone:209-617-1912
Mailing Address - Fax:209-358-2333
Practice Address - Street 1:528 E BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-2339
Practice Address - Country:US
Practice Address - Phone:209-617-1912
Practice Address - Fax:209-358-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0278960Medicare ID - Type Unspecified