MEDICARE: DR. SUSAN D RIVARD D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	3220	CO
2	111NN1001X	Nutrition Chiropractor	3220	CO

General Provider Information

NPI Number	:	1023450178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN D RIVARD D.C.

Provider Business Mailing Address
First Line	:	1814 N WAHSATCH AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7604
Country	:	US
Telephone Number	:	719-422-6643
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 WINDCHIME PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1984
Country	:	US
Telephone Number	:	719-598-6955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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