Healthcare Provider Details

I. General information

NPI: 1811392806
Provider Name (Legal Business Name): AMANDA SUCHKO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 E HOLLISTER ST STE 101
CINCINNATI OH
45219-1784
US

IV. Provider business mailing address

PO BOX 700688
SAN ANTONIO TX
78270-0688
US

V. Phone/Fax

Practice location:
  • Phone: 800-404-6050
  • Fax: 866-313-3397
Mailing address:
  • Phone: 210-477-7654
  • Fax: 210-468-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010949
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC04573
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: