Provider Demographics
NPI:1245648054
Name:HERVI, SUZANNE (LMT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HERVI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CAPISTA DR.
Mailing Address - Street 2:COMMUNITY CHIROPRACTIC CENTER
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404
Mailing Address - Country:US
Mailing Address - Phone:815-609-6150
Mailing Address - Fax:219-203-2925
Practice Address - Street 1:127 CAPISTA DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-8551
Practice Address - Country:US
Practice Address - Phone:815-609-6150
Practice Address - Fax:219-203-2925
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227015609225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist