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Individual
SUSAN LEGENDER CLARKE
Active
Individual
SUSAN LEGENDER CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
2143
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041101001
METROPOLITAN HEALTH PLAN
MN
01
—
0N438CL
BCBS INDIVIDUAL PROVIDER
MN
01
—
20705
HEALTHPARTNERS ID
MN
01
—
21316CL
BCBS CLINIC #
MN
01
—
350056171
RRCARE
MN
05
—
777027800
—
MN
Enumeration date
10/11/2005
Last updated
06/16/2010
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