Provider Demographics
NPI:1467637066
Name:SUMMERALL, SUSAN E (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:SUMMERALL
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2952
Mailing Address - Country:US
Mailing Address - Phone:803-276-4494
Mailing Address - Fax:803-276-4495
Practice Address - Street 1:195 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2952
Practice Address - Country:US
Practice Address - Phone:803-276-4494
Practice Address - Fax:803-276-4495
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist