Provider Demographics
NPI:1851339733
Name:WILLIAMSON, SUZANNE M (DC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:WILLIAMSON
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 1:3445 PENROSE PL
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1878
Mailing Address - Country:US
Mailing Address - Phone:303-447-0313
Mailing Address - Fax:
Practice Address - Street 1:3445 PENROSE PL
Practice Address - Street 2:SUITE 140
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1878
Practice Address - Country:US
Practice Address - Phone:303-447-0313
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3571111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC28173Medicare ID - Type Unspecified
CO28173Medicare UPIN