Provider Demographics
NPI:1780672436
Name:LARKIN THIER, SUSAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:LARKIN THIER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:LARKIN-THIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3048 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2793
Mailing Address - Country:US
Mailing Address - Phone:563-323-1551
Mailing Address - Fax:563-359-0926
Practice Address - Street 1:3048 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2793
Practice Address - Country:US
Practice Address - Phone:563-323-1551
Practice Address - Fax:563-359-0926
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00035OtherBLUE CROSS BLUE SHIELD
IAT01222Medicare UPIN
IA00035Medicare ID - Type Unspecified