MEDICARE: DR. SUSAN ELAINE RICHARDS 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	2558	OH
2	111N00000X	Chiropractor	0104556450	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679543144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN ELAINE RICHARDS DC

Provider Business Mailing Address
First Line	:	4639 GLENCOE LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6373
Country	:	US
Telephone Number	:	757-309-6679
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 GENERAL BOOTH BLVD
Second Line	:	SUITE #101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5876
Country	:	US
Telephone Number	:	757-430-0990
Fax Number	:	757-430-6860

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/09/2007

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