Provider Demographics
NPI:1437627734
Name:SUSIE, ASHLEY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LYNN
Last Name:SUSIE
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 1:1495 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-1920
Mailing Address - Country:US
Mailing Address - Phone:563-503-2802
Mailing Address - Fax:
Practice Address - Street 1:3008 LINCOLN WAY STE B
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7240
Practice Address - Country:US
Practice Address - Phone:563-503-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003073A111N00000X
IA094120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor