Provider Demographics
NPI:1447316559
Name:CASTILLO, SUSAN ANN (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:CASTILLO
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 1:203 E GOWE ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5919
Mailing Address - Country:US
Mailing Address - Phone:253-854-7322
Mailing Address - Fax:253-854-4761
Practice Address - Street 1:203 E GOWE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5919
Practice Address - Country:US
Practice Address - Phone:253-854-7322
Practice Address - Fax:253-854-4761
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor