MEDICARE: DR. VIKKI SUZANNE SUTHERLAND D.C.

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	DC20001	CA

General Provider Information

NPI Number	:	1710193263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIKKI SUZANNE SUTHERLAND D.C.

Provider Business Mailing Address
First Line	:	2635 CLEVELAND AVE
Second Line	:	STE 1
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2989
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 CLEVELAND AVE
Second Line	:	STE 1
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2989
Country	:	US
Telephone Number	:	707-546-4105
Fax Number	:	707-546-1375

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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