Provider Demographics
NPI:1023218708
Name:AUDETTE, SUE ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ELLEN
Last Name:AUDETTE
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 1:1672 SHARPTON TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6555
Mailing Address - Country:US
Mailing Address - Phone:770-560-0423
Mailing Address - Fax:770-995-7335
Practice Address - Street 1:1672 SHARPTON TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6555
Practice Address - Country:US
Practice Address - Phone:770-560-0423
Practice Address - Fax:770-995-7335
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor