MEDICARE: DR. SUSAN HENDRICKS PEZZIN 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	111NN1001X	Nutrition Chiropractor	1145	OH

General Provider Information

NPI Number	:	1427266600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN HENDRICKS PEZZIN D.C.

Provider Business Mailing Address
First Line	:	210 S REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-5989
Country	:	US
Telephone Number	:	419-866-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-5989
Country	:	US
Telephone Number	:	419-866-8500
Fax Number	:

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

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	07/08/2007

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