MEDICARE: JOHN E SUTHERLAND

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	111N00000X	Chiropractor	644	OH

General Provider Information

NPI Number	:	1942210521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E SUTHERLAND

Provider Business Mailing Address
First Line	:	1825 N REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615
Country	:	US
Telephone Number	:	419-537-6669
Fax Number	:	419-537-0144

Provider Business Practice Location Address
First Line	:	1825 N REYNOLDS RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615
Country	:	US
Telephone Number	:	419-537-6669
Fax Number	:	419-537-0144

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/30/2007

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