Provider Demographics
NPI:1568404168
Name:SHURBET, SUZANNE J (DC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:J
Last Name:SHURBET
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 1:6402 S 23 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:BOON
Mailing Address - State:MI
Mailing Address - Zip Code:49618-9707
Mailing Address - Country:US
Mailing Address - Phone:575-654-3416
Mailing Address - Fax:
Practice Address - Street 1:1406 S I 75 BUSINESS LOOP
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-2022
Practice Address - Country:US
Practice Address - Phone:989-348-4560
Practice Address - Fax:989-348-1663
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT96965Medicare UPIN