Provider Demographics
NPI:1477680510
Name:MARDOIAN, SUSAN B (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:MARDOIAN
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 1:600 ECHO LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3434
Mailing Address - Country:US
Mailing Address - Phone:847-729-2909
Mailing Address - Fax:
Practice Address - Street 1:600 ECHO LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3434
Practice Address - Country:US
Practice Address - Phone:847-729-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL347070Medicare ID - Type Unspecified