Provider Demographics
NPI:1841346491
Name:COSMOS, SUZANNE M (DC)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:COSMOS
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 1:12 W CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4591
Mailing Address - Country:US
Mailing Address - Phone:508-650-9794
Mailing Address - Fax:508-650-9273
Practice Address - Street 1:12 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4591
Practice Address - Country:US
Practice Address - Phone:508-650-9794
Practice Address - Fax:508-650-9273
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1611178Medicaid
MAY36486OtherBCBS
MAY36486OtherBCBS