Provider Demographics
NPI:1396809497
Name:CURTIS, SUSAN D (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:CURTIS
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 1:126 N SIBLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-2139
Mailing Address - Country:US
Mailing Address - Phone:320-693-3655
Mailing Address - Fax:320-693-5745
Practice Address - Street 1:126 N SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-2139
Practice Address - Country:US
Practice Address - Phone:320-693-3655
Practice Address - Fax:320-693-5745
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN652027800OtherMEDICAL ASSISTANCE ID
MN4C317CUOtherBLUE CROSS BLUE SHIELD
MN44-48144OtherMEDICA ID
MN652027800Medicaid
MN4C315Medicare UPIN
MN652027800OtherMEDICAL ASSISTANCE ID