Provider Demographics
NPI:1336132380
Name:AUBUCHON, SUSAN JANE (RN, DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JANE
Last Name:AUBUCHON
Suffix:
Gender:F
Credentials:RN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 1/2 4TH ST
Mailing Address - Street 2:STE 4A
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4460
Mailing Address - Country:US
Mailing Address - Phone:208-798-5420
Mailing Address - Fax:208-798-5430
Practice Address - Street 1:3316 1/2 4TH ST
Practice Address - Street 2:STE 4A
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4460
Practice Address - Country:US
Practice Address - Phone:208-798-5420
Practice Address - Fax:208-798-5430
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC8901OtherBLUE CROSS OF IDAHO
ID1673708Medicare PIN
IDU68815Medicare UPIN