Provider Demographics
NPI:1578647384
Name:COCO, SUSAN MARGARET (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARGARET
Last Name:COCO
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 1:2 SOUTH STONE AVE
Mailing Address - Street 2:DR SUSAN M COCO
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2217
Mailing Address - Country:US
Mailing Address - Phone:708-354-6611
Mailing Address - Fax:708-354-6611
Practice Address - Street 1:2 SOUTH STONE AVE
Practice Address - Street 2:DR SUSAN M COCO
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2217
Practice Address - Country:US
Practice Address - Phone:708-354-6611
Practice Address - Fax:708-354-6611
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL775080Medicare ID - Type Unspecified
T38901Medicare UPIN