Provider Demographics
NPI:1720108087
Name:WAHLERS, SUE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:WAHLERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:SANDHAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3327 W MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1243
Mailing Address - Country:US
Mailing Address - Phone:602-375-0331
Mailing Address - Fax:
Practice Address - Street 1:13811 N 35TH DR STE D
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5524
Practice Address - Country:US
Practice Address - Phone:602-993-2009
Practice Address - Fax:602-993-2028
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0234040OtherBLUE CROSS BLUE SHIELD AZ
AZAZ0234040OtherBLUE CROSS BLUE SHIELD AZ