Provider Demographics
NPI:1518481407
Name:DORADO, SUE ELAINE (DC, CCSP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELAINE
Last Name:DORADO
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ELAINE
Other - Last Name:DORADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, CCSP
Mailing Address - Street 1:11835 CARMEL MOUNTAIN RD # 1304-314
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 CAMINO DEL RIO S STE 308
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3849
Practice Address - Country:US
Practice Address - Phone:858-375-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33927111N00000X
CADC33927111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
6184OtherAMERICAN CHIROPRACTIC BOARD OF SPORTS PHYSICIANS