Provider Demographics
NPI:1700978582
Name:HARRIS, SUZANNE M (DC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 IDX DR
Mailing Address - Street 2:STE 235
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7773
Mailing Address - Country:US
Mailing Address - Phone:802-863-5828
Mailing Address - Fax:802-863-9619
Practice Address - Street 1:41 IDX DR
Practice Address - Street 2:STE 235
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7773
Practice Address - Country:US
Practice Address - Phone:802-863-5828
Practice Address - Fax:802-863-9619
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060001082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT49890OtherBLUE CROSS BLUE SHIELD
VT559660OtherCIGNA INDIVIDUAL #
VT10907045OtherCAQH UNIVERSAL CREDENTIAL
VT49890OtherBLUE CROSS BLUE SHIELD
VT10907045OtherCAQH UNIVERSAL CREDENTIAL