Provider Demographics
NPI:1306967179
Name:MONBARREN, SUSAN (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MONBARREN
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 1:8035 PROVIDENCE RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8035 PROVIDENCE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9716
Practice Address - Country:US
Practice Address - Phone:704-341-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3198OtherSTATE LICENSE
U19183Medicare UPIN
2878654Medicare ID - Type Unspecified