Provider Demographics
NPI:1568405876
Name:MARTIN, SUSAN MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MICHELLE
Last Name:MARTIN
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:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:EXMORE
Mailing Address - State:VA
Mailing Address - Zip Code:23350
Mailing Address - Country:US
Mailing Address - Phone:757-442-3444
Mailing Address - Fax:757-442-4913
Practice Address - Street 1:15399 MERRY CAT LANE
Practice Address - Street 2:STE 18
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-442-3444
Practice Address - Fax:757-442-4913
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA059603OtherBCBS
T21964Medicare UPIN