Provider Demographics
NPI:1871616938
Name:PROBYN, SUSANA MARLENE (DC)
Entity type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:MARLENE
Last Name:PROBYN
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 1:1058 S 73RD ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2709
Mailing Address - Country:US
Mailing Address - Phone:480-985-6745
Mailing Address - Fax:480-985-3040
Practice Address - Street 1:6047 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7517
Practice Address - Country:US
Practice Address - Phone:480-095-3040
Practice Address - Fax:480-985-3040
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79364Medicare UPIN