Provider Demographics
NPI:1225364839
Name:BATES, SUSAN ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANNE
Last Name:BATES
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 1:9660 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1119
Mailing Address - Country:US
Mailing Address - Phone:410-256-1672
Mailing Address - Fax:410-256-1674
Practice Address - Street 1:9660 BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1119
Practice Address - Country:US
Practice Address - Phone:410-256-1672
Practice Address - Fax:410-256-1674
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor