Provider Demographics
NPI:1902009582
Name:CRUMP - BAKER, SUSAN GENEVIEVE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GENEVIEVE
Last Name:CRUMP - BAKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:GENEVIEVE
Other - Last Name:CRUMP- BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11558 SAINT CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2729
Mailing Address - Country:US
Mailing Address - Phone:314-291-4401
Mailing Address - Fax:314-291-5879
Practice Address - Street 1:11558 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2729
Practice Address - Country:US
Practice Address - Phone:314-291-4401
Practice Address - Fax:314-291-5879
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000030160Medicare PIN