Provider Demographics
NPI:1396813911
Name:ANDERSON, SUE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:ANDERSON
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 1:2210 S HURON PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5151
Mailing Address - Country:US
Mailing Address - Phone:734-973-9692
Mailing Address - Fax:734-973-9693
Practice Address - Street 1:2210 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5151
Practice Address - Country:US
Practice Address - Phone:734-973-9692
Practice Address - Fax:734-973-9693
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H15024Medicare ID - Type Unspecified
MIU17520Medicare UPIN