Provider Demographics
NPI:1295893212
Name:DAVIS, SUZANNE (DC)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:DAVIS
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:213 GHANER DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1172
Mailing Address - Country:US
Mailing Address - Phone:814-234-8900
Mailing Address - Fax:814-234-8909
Practice Address - Street 1:2134 SANDY DR
Practice Address - Street 2:SUITE 9
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2292
Practice Address - Country:US
Practice Address - Phone:814-234-8900
Practice Address - Fax:814-234-8909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA162197ZELNMedicare PIN
PAV00031Medicare UPIN