Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH5937 | FL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | CH5937 | FL |
NPI | 1801863402 |
---|---|
Provider Name | Susan V Ville |
First Address | Melbourne, FL 32901-5591 |
Second Address | Melbourne, FL 32901-5594 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
382129300 | (05) | FL |
U00842 | (02) |