Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038005163 | IL |
NPI | 1003925983 |
---|---|
Provider Name | Dr. Susan Lynn Streiff |
First Address | Gurnee, IL 60031-3393 |
Second Address | Gurnee, IL 60031-3393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01683025 | BLUE SHIELD OF ILLINOIS (01) | IL |