Provider Demographics
NPI:1700934015
Name:SUYAK, JOHN R JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SUYAK
Suffix:JR
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 1:88 LAMAR ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2498
Mailing Address - Country:US
Mailing Address - Phone:303-439-0333
Mailing Address - Fax:303-439-0435
Practice Address - Street 1:88 LAMAR ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2498
Practice Address - Country:US
Practice Address - Phone:303-439-0333
Practice Address - Fax:303-439-0435
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC475698OtherGROUP #
COC475708Medicare UPIN