Provider Demographics
NPI:1194801779
Name:CHANDLER, SUSAN GAIL (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GAIL
Last Name:CHANDLER
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:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-0835
Mailing Address - Country:US
Mailing Address - Phone:704-845-8499
Mailing Address - Fax:704-845-5321
Practice Address - Street 1:1340 MATTHEWS TOWNSHIP PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4681
Practice Address - Country:US
Practice Address - Phone:704-845-8499
Practice Address - Fax:704-845-5321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT64511Medicare UPIN
NC244491AMedicare ID - Type UnspecifiedMEDICARE