Provider Demographics
NPI:1740407543
Name:FELDMANN, SUZANNE DENISE (DC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:DENISE
Last Name:FELDMANN
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 1:220 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-2435
Mailing Address - Country:US
Mailing Address - Phone:309-734-2460
Mailing Address - Fax:
Practice Address - Street 1:1210 N 24TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2233
Practice Address - Country:US
Practice Address - Phone:217-223-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
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
ILT42122Medicare UPIN
IL956-580Medicare ID - Type Unspecified