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NPI Code Detail

MEDICARE: SUSSEX CHIROPRACTIC, PA

MEDICARE: SUSSEX CHIROPRACTIC, PA
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
1111N00000XChiropractor519NM

General Provider Information

NPI Number : 1871508242
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUSSEX CHIROPRACTIC, PA
Provider Business Mailing Address
First Line : 4740 N BUTLER AVE
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-0826
Country : US
Telephone Number : 505-325-2604
Fax Number :
Provider Business Practice Location Address
First Line : 4740 N BUTLER AVE
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-0826
Country : US
Telephone Number : 505-325-2604
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. RANDALL M SUSSEX
Credential : D.C.
Telephone Number : 505-325-2604
Provider Enumeration Date : 07/31/2006
Last Update Date : 08/22/2020

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Directions to “SUSSEX CHIROPRACTIC, PA ” Practice Location

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