Provider Demographics
NPI:1871771113
Name:PETERSEN, SUZANNE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:PETERSEN
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 1:2351 SUNSET BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4341
Mailing Address - Country:US
Mailing Address - Phone:916-624-2500
Mailing Address - Fax:916-624-4196
Practice Address - Street 1:2351 SUNSET BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4341
Practice Address - Country:US
Practice Address - Phone:916-624-2500
Practice Address - Fax:916-624-4196
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor