Provider Demographics
NPI:1932677762
Name:SUCKOO, PATRICK GEORGE (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GEORGE
Last Name:SUCKOO
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 1:8577 HAVEN AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4850
Mailing Address - Country:US
Mailing Address - Phone:909-783-5210
Mailing Address - Fax:800-783-5210
Practice Address - Street 1:8577 HAVEN AVE STE 210
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4850
Practice Address - Country:US
Practice Address - Phone:909-783-5210
Practice Address - Fax:800-783-5210
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28539111N00000X
CADC28539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor