Provider Demographics
NPI:1952471294
Name:GORDON-ARNTSON, SUSAN ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:GORDON-ARNTSON
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 1:6491 SAN RU AVE STE B
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8185
Mailing Address - Country:US
Mailing Address - Phone:616-669-8880
Mailing Address - Fax:616-669-2241
Practice Address - Street 1:6491 SAN RU AVE STE B
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8185
Practice Address - Country:US
Practice Address - Phone:616-669-8880
Practice Address - Fax:616-669-2241
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2998523Medicaid
MI46254Medicare UPIN
MI2998523Medicaid