MEDICARE: DR. SUSAN R DETWEILER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038.007307	IL

General Provider Information

NPI Number	:	1467889808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN R DETWEILER D.C.

Provider Business Mailing Address
First Line	:	1141 BUFFALO MECH RD
Second Line	:
City	:	DAWSON
State	:	IL
Zip	:	62520-3153
Country	:	US
Telephone Number	:	469-831-9668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 BUFFALO MECH RD
Second Line	:
City	:	DAWSON
State	:	IL
Zip	:	62520-3153
Country	:	US
Telephone Number	:	469-831-9668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	09/30/2013

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