Provider Demographics
NPI:1659341840
Name:HERDA, SUSAN LAURIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LAURIE
Last Name:HERDA
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 1:4960 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:MAPLE PLAIN
Mailing Address - State:MN
Mailing Address - Zip Code:55359-8729
Mailing Address - Country:US
Mailing Address - Phone:763-479-3388
Mailing Address - Fax:763-479-6258
Practice Address - Street 1:4960 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:MAPLE PLAIN
Practice Address - State:MN
Practice Address - Zip Code:55359-8729
Practice Address - Country:US
Practice Address - Phone:763-479-3388
Practice Address - Fax:763-479-6258
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4872111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic