Healthcare Provider Details

I. General information

NPI: 1851339733
Provider Name (Legal Business Name): SUZANNE M WILLIAMSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PENROSE PL SUITE 140
BOULDER CO
80301-1878
US

IV. Provider business mailing address

3445 PENROSE PL SUITE 140
BOULDER CO
80301-1878
US

V. Phone/Fax

Practice location:
  • Phone: 303-447-0313
  • Fax:
Mailing address:
  • Phone: 303-447-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3571
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: