Provider Demographics
NPI:1538246897
Name:DUDKO, SUZANNE (DC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:DUDKO
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 1:9010 LORTON STATION BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4792
Mailing Address - Country:US
Mailing Address - Phone:703-436-2207
Mailing Address - Fax:703-879-3484
Practice Address - Street 1:9010 LORTON STATION BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4792
Practice Address - Country:US
Practice Address - Phone:703-436-2207
Practice Address - Fax:703-879-3484
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02070Medicare ID - Type Unspecified