Provider Demographics
NPI:1154312205
Name:STROM, SUSAN ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:STROM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:STROM
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2456 NW NORTHRUP ST
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3253
Mailing Address - Country:US
Mailing Address - Phone:503-223-6414
Mailing Address - Fax:503-243-6632
Practice Address - Street 1:2456 NW NORTHRUP ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3253
Practice Address - Country:US
Practice Address - Phone:503-223-6414
Practice Address - Fax:503-243-6632
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T68175Medicare UPIN
OR103338Medicare ID - Type Unspecified