Provider Demographics
NPI:1316075377
Name:FLEUCHAUS, SUSAN L (DC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:FLEUCHAUS
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 1:5027 GREEN BAY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5027 GREEN BAY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1771
Practice Address - Country:US
Practice Address - Phone:262-652-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2998-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000135455Medicare ID - Type Unspecified
WIU43829Medicare UPIN