Provider Demographics
NPI:1619985595
Name:NACCARATO, SUSAN J (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:NACCARATO
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 1:21651 E COUNTRY VISTA DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7708
Mailing Address - Country:US
Mailing Address - Phone:509-319-2310
Mailing Address - Fax:
Practice Address - Street 1:21651 E COUNTRY VISTA DR
Practice Address - Street 2:SUITE F
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7708
Practice Address - Country:US
Practice Address - Phone:509-319-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8801715Medicare PIN
U84608Medicare UPIN