Provider Demographics
NPI:1972789634
Name:SUSSEX, STEVEN SAFFORD I (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SAFFORD
Last Name:SUSSEX
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2122
Mailing Address - Country:US
Mailing Address - Phone:719-589-5861
Mailing Address - Fax:
Practice Address - Street 1:1407 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2122
Practice Address - Country:US
Practice Address - Phone:719-589-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1200111N00000X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC1479Medicare UPIN