Provider Demographics
NPI:1669696183
Name:ANDERSON, SUSAN ANN (DC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:ANDERSON
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 1:1395 JORDAN ST STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4759
Mailing Address - Country:US
Mailing Address - Phone:319-625-2225
Mailing Address - Fax:319-625-2227
Practice Address - Street 1:1395 JORDAN ST STE D
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4759
Practice Address - Country:US
Practice Address - Phone:319-625-2225
Practice Address - Fax:319-625-2227
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151472Medicaid
IA58531OtherBCBS
IAI9820OtherMEDICARE