1902009582 NPI number — DR. SUSAN GENEVIEVE CRUMP - BAKER D.C.

Table of content: DR. SUSAN GENEVIEVE CRUMP - BAKER D.C. (NPI 1902009582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902009582 NPI number — DR. SUSAN GENEVIEVE CRUMP - BAKER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUMP - BAKER
Provider First Name:
SUSAN
Provider Middle Name:
GENEVIEVE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRUMP- BAKER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
GENEVIEVE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902009582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11558 SAINT CHARLES ROCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-291-4401
Provider Business Mailing Address Fax Number:
314-291-5879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11558 SAINT CHARLES ROCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63044-2729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-291-4401
Provider Business Practice Location Address Fax Number:
314-291-5879
Provider Enumeration Date:
06/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  003324 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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