Provider Demographics
NPI:1427002997
Name:BRIGGS, SUSIE MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:MARIE
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:STREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1643 N ALPINE RD STE 104
Mailing Address - Street 2:PMB 149
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1464
Mailing Address - Country:US
Mailing Address - Phone:815-398-8023
Mailing Address - Fax:815-399-2430
Practice Address - Street 1:818 COOLIDGE PLACE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107
Practice Address - Country:US
Practice Address - Phone:815-398-8023
Practice Address - Fax:815-399-2430
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U38426Medicare UPIN
IL203782Medicare PIN