Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 000678 | CT |
NPI | 1477686525 |
---|---|
Provider Name | Dr. Susan G. Mccoll |
First Address | Deep River, CT 06417-2052 |
Second Address | Haddam, CT 06438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22604 | (02) | CT |