Provider Demographics
NPI:1740333541
Name:LAMBERT, SUSAN LUCILLE (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LUCILLE
Last Name:LAMBERT
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 1:2236 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1447
Mailing Address - Country:US
Mailing Address - Phone:563-343-2241
Mailing Address - Fax:563-359-3144
Practice Address - Street 1:2236 E 46TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1447
Practice Address - Country:US
Practice Address - Phone:563-343-2241
Practice Address - Fax:563-359-3144
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0264697Medicaid
IA29334OtherWELLMARK
IA0264697Medicaid