MEDICARE: DR THOMAS M SUVADA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104000690	VA

General Provider Information

NPI Number	:	1275802415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR THOMAS M SUVADA PC

Provider Business Mailing Address
First Line	:	5505 INDIAN RIVER RD
Second Line	:	SUITE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5252
Country	:	US
Telephone Number	:	757-420-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	5505 INDIAN RIVER RD
Second Line	:	SUITE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5252
Country	:	US
Telephone Number	:	757-420-5505
Fax Number	:	757-420-3422

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS SUVADA
Credential	:	DC
Telephone Number	:	757-420-5505

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	12/16/2011

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