Healthcare Provider Details

I. General information

NPI: 1386674190
Provider Name (Legal Business Name): SUSANA DENISE SILVEIRA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 E BELLEVUE RD
ATWATER CA
95301-2339
US

IV. Provider business mailing address

528 E BELLEVUE RD
ATWATER CA
95301-2339
US

V. Phone/Fax

Practice location:
  • Phone: 209-617-1912
  • Fax: 209-358-2333
Mailing address:
  • Phone: 209-617-1912
  • Fax: 209-358-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: