Provider Demographics
NPI:1437270790
Name:DISKIC, SUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:DISKIC
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 1:15300 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1012
Mailing Address - Country:US
Mailing Address - Phone:586-774-1550
Mailing Address - Fax:586-774-9583
Practice Address - Street 1:15300 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1012
Practice Address - Country:US
Practice Address - Phone:586-774-1550
Practice Address - Fax:586-774-9583
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor