Provider Demographics
NPI:1396837621
Name:MULCAHEY, SUSAN LEE (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:MULCAHEY
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 1:2721 W SIXTH STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-832-9355
Mailing Address - Fax:785-832-9356
Practice Address - Street 1:2721 W SIXTH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-832-9355
Practice Address - Fax:785-832-9356
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
27044031OtherBCBS OF KANSAS CITY
60926OtherBCBS OF KS
27044031OtherBCBS OF KANSAS CITY
KS060926Medicare ID - Type UnspecifiedINDIV
60926OtherBCBS OF KS