MEDICARE: DR. SUSAN HOLTQUIST FRAIN 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	3922-012	WI

General Provider Information

NPI Number	:	1760556161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN HOLTQUIST FRAIN D.C.

Provider Business Mailing Address
First Line	:	860 HANSEN RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5324
Country	:	US
Telephone Number	:	920-499-1333
Fax Number	:	920-499-2444

Provider Business Practice Location Address
First Line	:	860 HANSEN RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5324
Country	:	US
Telephone Number	:	920-499-1333
Fax Number	:	920-499-2444

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	04/10/2019

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