Provider Demographics
NPI:1922300029
Name:EISSINGER, SUSAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:EISSINGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:EISSINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1544 HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-2906
Mailing Address - Country:US
Mailing Address - Phone:530-824-1851
Mailing Address - Fax:
Practice Address - Street 1:1544 HERBERT AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-2906
Practice Address - Country:US
Practice Address - Phone:530-824-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicare PIN