Provider Demographics
NPI:1356408793
Name:SUCCOP, JEREMY BENZ (DC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:BENZ
Last Name:SUCCOP
Suffix:
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 1:3424 WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 168
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5444
Mailing Address - Country:US
Mailing Address - Phone:412-823-2180
Mailing Address - Fax:412-823-6165
Practice Address - Street 1:3424 WILLIAM PENN HWY
Practice Address - Street 2:SUITE 168
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5444
Practice Address - Country:US
Practice Address - Phone:412-823-2180
Practice Address - Fax:412-823-6165
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016689OtherBLUE SHIELD
PA086764Medicare ID - Type Unspecified