Provider Demographics
NPI:1942378815
Name:DR. SUE ANDERSON PLLC
Entity Type:Organization
Organization Name:DR. SUE ANDERSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR-OWNER-SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-973-9692
Mailing Address - Street 1:2210 S HURON PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5151
Mailing Address - Country:US
Mailing Address - Phone:734-973-9692
Mailing Address - Fax:734-973-9693
Practice Address - Street 1:2210 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5151
Practice Address - Country:US
Practice Address - Phone:734-973-9692
Practice Address - Fax:734-973-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H150240OtherBLUE CROSS BLUE SHIELD
MIU17520Medicare UPIN
MI950H150240OtherBLUE CROSS BLUE SHIELD