Provider Demographics
NPI:1306142880
Name:BIRCH, SUSAN ANN (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:BIRCH
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 485
Mailing Address - Street 2:
Mailing Address - City:TAHOE VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:96148-0485
Mailing Address - Country:US
Mailing Address - Phone:530-320-2225
Mailing Address - Fax:831-536-1092
Practice Address - Street 1:216 LARK CT
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-9745
Practice Address - Country:US
Practice Address - Phone:530-546-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17018111N00000X
NVB 314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor