Provider Demographics
NPI:1063561199
Name:ARIMA, SUSAN CHRISTINE (LIC ACUPUNCTURITST)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:ARIMA
Suffix:
Gender:F
Credentials:LIC ACUPUNCTURITST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CEDAR ST
Mailing Address - Street 2:PMB#170
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1410
Mailing Address - Country:US
Mailing Address - Phone:208-255-2989
Mailing Address - Fax:
Practice Address - Street 1:101 N 4TH AVE
Practice Address - Street 2:#103
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1361
Practice Address - Country:US
Practice Address - Phone:208-255-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU49171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist