Provider Demographics
NPI:1508915976
Name:WALETKUS, SUSAN FRANCES (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FRANCES
Last Name:WALETKUS
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 1:283 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1910
Mailing Address - Country:US
Mailing Address - Phone:781-585-0585
Mailing Address - Fax:781-585-0586
Practice Address - Street 1:283 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1910
Practice Address - Country:US
Practice Address - Phone:781-585-0585
Practice Address - Fax:781-585-0586
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0018410OtherNEIGHBORHOOD
MA402656OtherTUFTS
MA35851OtherHARVARD PILGRIM
MAY39589OtherBLUE CROSS BLUE SHIELD
MA1612905Medicaid
MAY36466OtherBLUE CROSS BLUE SHIELD
MA35851OtherHARVARD PILGRIM
MAY25028Medicare ID - Type UnspecifiedMEDICARE