Provider Demographics
NPI:1093713711
Name:PHAM, SUSAN H (DC, DAAPM, DACBN)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:PHAM
Suffix:
Gender:F
Credentials:DC, DAAPM, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4796
Mailing Address - Country:US
Mailing Address - Phone:651-642-1110
Mailing Address - Fax:651-642-1113
Practice Address - Street 1:995 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4796
Practice Address - Country:US
Practice Address - Phone:651-642-1110
Practice Address - Fax:651-642-1113
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3532111NN1001X
MN411171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN232018OtherACN
MN5C969 PHOtherBCBS-MN
MN232018OtherACN