MEDICARE: MR. SERGIO V SUAREZ 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	111N00000X	Chiropractor	DC25184	CA

General Provider Information

NPI Number	:	1487797742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SERGIO V SUAREZ DC

Provider Business Mailing Address
First Line	:	2027 GRAND CANAL BLVD STE 21
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6650
Country	:	US
Telephone Number	:	209-957-9601
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 GRAND CANAL BLVD STE 21
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6650
Country	:	US
Telephone Number	:	209-957-9601
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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