Provider Demographics
NPI:1891987459
Name:LEVY, SUZANA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUZANA
Middle Name:ROSE
Last Name:LEVY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 NE BROADWAY ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1569
Mailing Address - Country:US
Mailing Address - Phone:503-719-5000
Mailing Address - Fax:971-255-1754
Practice Address - Street 1:2100 NE BROADWAY ST
Practice Address - Street 2:SUITE 225
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1569
Practice Address - Country:US
Practice Address - Phone:503-719-5000
Practice Address - Fax:971-255-1754
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor