Provider Demographics
NPI:1871855007
Name:SURRIDGE, MARY R (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:R
Last Name:SURRIDGE
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 1:5819 NW BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1494
Mailing Address - Country:US
Mailing Address - Phone:816-436-8200
Mailing Address - Fax:816-436-8210
Practice Address - Street 1:5819 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1494
Practice Address - Country:US
Practice Address - Phone:816-436-8200
Practice Address - Fax:816-436-8210
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012015451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor