Provider Demographics
NPI:1881750099
Name:LANKER, SUSAN MICHAEL (DC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MICHAEL
Last Name:LANKER
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 1:150 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2908
Mailing Address - Country:US
Mailing Address - Phone:503-440-0416
Mailing Address - Fax:
Practice Address - Street 1:150 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2908
Practice Address - Country:US
Practice Address - Phone:503-440-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3178111N00000X
OH2734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
72668Medicare UPIN
OR115559Medicare PIN
OR115558Medicare ID - Type UnspecifiedGROUP #