Provider Demographics
NPI:1578540316
Name:DEMITH-OLSON, SUSAN M (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:DEMITH-OLSON
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 1:7831 E. WRIGHTSTOWN ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4345
Mailing Address - Country:US
Mailing Address - Phone:520-885-7944
Mailing Address - Fax:520-885-8350
Practice Address - Street 1:7831 E WRIGHTSTOWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4344
Practice Address - Country:US
Practice Address - Phone:520-885-7944
Practice Address - Fax:520-885-8350
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0934770OtherBLUE CROSS BLUE SHIELD
AZZ28771Medicare ID - Type Unspecified