Vikki Suzanne Sutherland, D.C.

Key facts

NPI

1710193263

Entity type

Individual (NPI type 1)

Primary specialty

Chiropractor 111N00000X

License

DC20001 (CA)

Practice address

2635 Cleveland Ave
Ste 1
Santa Rosa, CA 95403-2989

Phone

(707) 546-4105

Fax

(707) 546-1375

NPI assigned

May 14, 2007

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710193263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 CLEVELAND AVE",
            "address_2": "STE 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 CLEVELAND AVE",
            "address_2": "STE 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032989",
            "telephone_number": "707-546-4105",
            "fax_number": "707-546-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "VIKKI",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC20001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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