Healthcare Provider Details

I. General information

NPI: 1326008434
Provider Name (Legal Business Name): SUSAN L BLATT DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 N MAIN ST SUITE 9
EAGAR AZ
85925-9676
US

IV. Provider business mailing address

367 N MAIN ST SUITE 9
EAGAR AZ
85925-9676
US

V. Phone/Fax

Practice location:
  • Phone: 928-333-4757
  • Fax: 928-333-4757
Mailing address:
  • Phone: 928-333-4757
  • Fax: 928-333-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BLATT
Title or Position: OWNER
Credential: DC
Phone: 928-333-4757