Provider Demographics
NPI:1053404079
Name:MULLEN, SUSAN V (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:V
Last Name:MULLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3321
Mailing Address - Country:US
Mailing Address - Phone:510-356-4048
Mailing Address - Fax:510-356-4137
Practice Address - Street 1:2620 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3321
Practice Address - Country:US
Practice Address - Phone:510-356-4048
Practice Address - Fax:510-356-4137
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0253560Medicare ID - Type Unspecified