Provider Demographics
NPI:1679543144
Name:RICHARDS, SUSAN ELAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELAINE
Last Name:RICHARDS
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 1:4639 GLENCOE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6373
Mailing Address - Country:US
Mailing Address - Phone:757-309-6679
Mailing Address - Fax:
Practice Address - Street 1:2000 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5876
Practice Address - Country:US
Practice Address - Phone:757-430-0990
Practice Address - Fax:757-430-6860
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2558111N00000X
VA0104556450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2234399Medicaid
OH2234399Medicaid
OHU67889Medicare UPIN