Provider Demographics
NPI:1215012257
Name:KIM, SUSAN MEEHAE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MEEHAE
Last Name:KIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MEEHAE
Other - Last Name:KIM-HUANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7590 AUBURN ROAD, SUITE 014
Mailing Address - Street 2:ATTN: MED STAFF
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9176
Mailing Address - Country:US
Mailing Address - Phone:440-354-1899
Mailing Address - Fax:440-354-1845
Practice Address - Street 1:8655 MARKET ST
Practice Address - Street 2:INTEGRATIVE MEDICINE 2ND FL
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-255-5508
Practice Address - Fax:440-357-4416
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2133364Medicaid
OH0893541Medicare ID - Type UnspecifiedMEDICARE
OH2133364Medicaid