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NPI Code Detail

MEDICARE: DR. JAN SUCKUT D.C.

MEDICARE:  DR. JAN  SUCKUT  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
1111N00000XChiropractor22865CA

General Provider Information

NPI Number : 1922002732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAN SUCKUT D.C.
Provider Business Mailing Address
First Line : 791 EISENHOWER WAY
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-8361
Country : US
Telephone Number : 805-813-3987
Fax Number :
Provider Business Practice Location Address
First Line : 2488 TAPO ST
Second Line : STE 2
City : SIMI VALLEY
State : CA
Zip : 93063-2492
Country : US
Telephone Number : 805-583-0895
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 04/04/2012

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Directions to “ DR. JAN SUCKUT D.C.” Practice Location

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