Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | JS006109 | MI |
NPI | 1003986829 |
---|---|
Provider Name | Jeannine Mary Suksi |
First Address | Port Huron, MI 48060-2543 |
Second Address | Port Huron, MI 48060-2543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 20/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0P29900 | (02) | MI |