Provider Demographics
NPI:1124236989
Name:MINDER, SUSAN MARIE (DC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:MINDER
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 1:2025 W ILES AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4190
Mailing Address - Country:US
Mailing Address - Phone:217-241-5300
Mailing Address - Fax:217-241-5322
Practice Address - Street 1:2025 W ILES AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4190
Practice Address - Country:US
Practice Address - Phone:217-241-5300
Practice Address - Fax:217-241-5322
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
84-20187OtherBLUE CROSS & BLUE SHIELD
339643OtherHEALTH LINK
310750Medicare ID - Type Unspecified
339643OtherHEALTH LINK