Provider Demographics
NPI:1740220706
Name:MITCHELL, SUSAN LADON (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LADON
Last Name:MITCHELL
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 1:1210 TOWANDA PLAZA
Mailing Address - Street 2:SUITE 17
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701
Mailing Address - Country:US
Mailing Address - Phone:309-828-6200
Mailing Address - Fax:309-828-6002
Practice Address - Street 1:1210 TOWANDA PLAZA
Practice Address - Street 2:SUITE 17
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-828-6200
Practice Address - Fax:309-828-6002
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5732071OtherBCBS
P00285708OtherPALMETTO GBA
DE3260OtherPALMETTO GBA
IL5732071OtherBCBS
DE3260OtherPALMETTO GBA