Healthcare Provider Details

I. General information

NPI: 1356374482
Provider Name (Legal Business Name): SUSAN MARIE KAUFMAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N TREMONT ST
KEWANEE IL
61443-2231
US

IV. Provider business mailing address

109 N TREMONT ST
KEWANEE IL
61443-2231
US

V. Phone/Fax

Practice location:
  • Phone: 309-854-6666
  • Fax: 309-856-5034
Mailing address:
  • Phone: 309-854-6666
  • Fax: 309-856-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: