Provider Demographics
NPI:1558566323
Name:DR. SUSAN R. STRADER, D.C.,P.C.
Entity Type:Organization
Organization Name:DR. SUSAN R. STRADER, D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:RUFENA
Authorized Official - Last Name:STRADER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-244-8738
Mailing Address - Street 1:5822 S SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2737
Mailing Address - Country:US
Mailing Address - Phone:720-244-8738
Mailing Address - Fax:
Practice Address - Street 1:5822 S SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2737
Practice Address - Country:US
Practice Address - Phone:720-244-8738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COX88649Medicare UPIN
COC494318Medicare PIN