MEDICARE: SUSAN L BLATT DC LLC

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

General Provider Information

NPI Number	:	1326008434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN L BLATT DC LLC

Provider Business Mailing Address
First Line	:	367 N MAIN ST
Second Line	:	SUITE 9
City	:	EAGAR
State	:	AZ
Zip	:	85925-9676
Country	:	US
Telephone Number	:	928-333-4757
Fax Number	:	928-333-4757

Provider Business Practice Location Address
First Line	:	367 N MAIN ST
Second Line	:	SUITE 9
City	:	EAGAR
State	:	AZ
Zip	:	85925-9676
Country	:	US
Telephone Number	:	928-333-4757
Fax Number	:	928-333-4757

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN BLATT
Credential	:	DC
Telephone Number	:	928-333-4757

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	01/16/2008

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Directions to “SUSAN L BLATT DC LLC ” Practice Location

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