Provider Demographics
NPI:1124189246
Name:LINHARDT, SUSAN E (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:LINHARDT
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 1:4444 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3316
Mailing Address - Country:US
Mailing Address - Phone:314-416-4100
Mailing Address - Fax:314-416-4141
Practice Address - Street 1:4444 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3316
Practice Address - Country:US
Practice Address - Phone:314-416-4100
Practice Address - Fax:314-416-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9558OtherANTHEM BCBS OF MO
MO000031667Medicare ID - Type Unspecified