Healthcare Provider Details

I. General information

NPI: 1023450178
Provider Name (Legal Business Name): SUSAN D RIVARD D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 WINDCHIME PL
COLORADO SPRINGS CO
80919-1984
US

IV. Provider business mailing address

1814 N WAHSATCH AVE
COLORADO SPRINGS CO
80907-7604
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-6955
  • Fax:
Mailing address:
  • Phone: 719-422-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number3220
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3220
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: