Provider Demographics
NPI:1760556161
Name:FRAIN, SUSAN HOLTQUIST (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HOLTQUIST
Last Name:FRAIN
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 1:860 HANSEN RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5324
Mailing Address - Country:US
Mailing Address - Phone:920-499-1333
Mailing Address - Fax:920-499-2444
Practice Address - Street 1:860 HANSEN RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5324
Practice Address - Country:US
Practice Address - Phone:920-499-1333
Practice Address - Fax:920-499-2444
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3922-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU94930Medicare UPIN
000135925Medicare ID - Type Unspecified