Provider Demographics
NPI:1538194907
Name:BOBAK, SUSAN N (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:N
Last Name:BOBAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 S EREMLAND DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3523
Mailing Address - Country:US
Mailing Address - Phone:626-859-6480
Mailing Address - Fax:626-859-6482
Practice Address - Street 1:646 S EREMLAND DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3523
Practice Address - Country:US
Practice Address - Phone:626-859-6480
Practice Address - Fax:626-859-6482
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14830111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition