Provider Demographics
NPI:1417072711
Name:SUSSMAN, NEIL A (DC)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:A
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N SHERIDAN RD
Mailing Address - Street 2:APT. 3301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1958
Mailing Address - Country:US
Mailing Address - Phone:773-935-9595
Mailing Address - Fax:773-935-5869
Practice Address - Street 1:3125 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4436
Practice Address - Country:US
Practice Address - Phone:773-935-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor