Provider Demographics
NPI:1396802187
Name:KILMER, SUSAN P (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:P
Last Name:KILMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3618 BRAMBLETON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3659
Mailing Address - Country:US
Mailing Address - Phone:540-989-4584
Mailing Address - Fax:540-725-5396
Practice Address - Street 1:3618 BRAMBLETON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3659
Practice Address - Country:US
Practice Address - Phone:540-989-4584
Practice Address - Fax:540-725-5396
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA281220OtherANTHEM BLUE CROSS
VA613468OtherACN GROUP
VA4565063OtherAETNA
VA64377OtherSOUTHERN HEALTH