Provider Demographics
NPI:1912148982
Name:KELLOGG, SUSAN K (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:KELLOGG
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 1:37 BANK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1703
Mailing Address - Country:US
Mailing Address - Phone:603-448-0222
Mailing Address - Fax:
Practice Address - Street 1:37 BANK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1703
Practice Address - Country:US
Practice Address - Phone:603-448-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0870392R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor