Provider Demographics
NPI:1518010768
Name:DUNCAN, SUSAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:DUNCAN
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 1:301 E MAYNE ST
Mailing Address - Street 2:
Mailing Address - City:BLUE GRASS
Mailing Address - State:IA
Mailing Address - Zip Code:52726-9794
Mailing Address - Country:US
Mailing Address - Phone:563-381-2010
Mailing Address - Fax:
Practice Address - Street 1:301 E MAYNE ST
Practice Address - Street 2:
Practice Address - City:BLUE GRASS
Practice Address - State:IA
Practice Address - Zip Code:52726-9794
Practice Address - Country:US
Practice Address - Phone:563-381-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04805111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0252395Medicaid
IA25239Medicare ID - Type Unspecified
IA0252395Medicaid