Healthcare Provider Details

I. General information

NPI: 1639266083
Provider Name (Legal Business Name): SUZAN I KUDICK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COOPER POINT RD SW #24A
OLYMPIA WA
98502-1178
US

IV. Provider business mailing address

PO BOX 2252
OLYMPIA WA
98507-2252
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-7360
  • Fax: 360-754-7022
Mailing address:
  • Phone: 360-943-7360
  • Fax: 360-754-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2433
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: