Provider Demographics
NPI:1699854687
Name:ALBERS, SUSAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:ALBERS
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 1:1001 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-8423
Mailing Address - Country:US
Mailing Address - Phone:636-978-3778
Mailing Address - Fax:636-978-3779
Practice Address - Street 1:1001 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-8423
Practice Address - Country:US
Practice Address - Phone:636-978-3778
Practice Address - Fax:636-978-3779
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031408Medicare ID - Type Unspecified
MOT43278Medicare UPIN