MEDICARE: DR. SUSAN G. MCCOLL DC

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	111NX0800X	Orthopedic Chiropractor	000678	CT

General Provider Information

NPI Number	:	1477686525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN G. MCCOLL DC

Provider Business Mailing Address
First Line	:	391 MAIN ST
Second Line	:	UNIT 507
City	:	DEEP RIVER
State	:	CT
Zip	:	06417-2052
Country	:	US
Telephone Number	:	203-640-2529
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 ROUTE 154
Second Line	:
City	:	HADDAM
State	:	CT
Zip	:	06438
Country	:	US
Telephone Number	:	860-345-5121
Fax Number	:	860-345-8262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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