Provider Demographics
NPI:1487836250
Name:PAUL, SUSMITA (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSMITA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:522 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4112
Mailing Address - Country:US
Mailing Address - Phone:703-777-2532
Mailing Address - Fax:703-777-8002
Practice Address - Street 1:522 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4112
Practice Address - Country:US
Practice Address - Phone:703-777-2532
Practice Address - Fax:703-777-8002
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor