Provider Demographics
NPI:1225223597
Name:ADDISON, SUSAN E (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:ADDISON
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 1:4207 SE WOODSTOCK BLVD
Mailing Address - Street 2:BOX 495
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206
Mailing Address - Country:US
Mailing Address - Phone:503-880-9204
Mailing Address - Fax:360-574-5991
Practice Address - Street 1:1340 SW BERTHA BLVD
Practice Address - Street 2:STE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2097
Practice Address - Country:US
Practice Address - Phone:503-880-9204
Practice Address - Fax:360-574-5991
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71 3760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor