Provider Demographics
NPI:1487825295
Name:SUZANNE D. LADY, DC, PC
Entity Type:Organization
Organization Name:SUZANNE D. LADY, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-223-0900
Mailing Address - Street 1:5517 N COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2339
Mailing Address - Country:US
Mailing Address - Phone:503-223-0900
Mailing Address - Fax:503-223-1188
Practice Address - Street 1:5517 N COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2339
Practice Address - Country:US
Practice Address - Phone:503-223-0900
Practice Address - Fax:503-223-1188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUZANNE D. LADY, DC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty