Provider Demographics
NPI:1689720393
Name:SOUCY, ALICE A (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:A
Last Name:SOUCY
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 1:172 SIAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-5837
Mailing Address - Country:US
Mailing Address - Phone:802-334-5941
Mailing Address - Fax:
Practice Address - Street 1:172 SIAS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5837
Practice Address - Country:US
Practice Address - Phone:802-334-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT8791Medicare UPIN