Healthcare Provider Details

I. General information

NPI: 1336884337
Provider Name (Legal Business Name): SULLIVAN HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 09/06/2023
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12151 E PALMER WASILLA HWY
PALMER AK
99645-8880
US

IV. Provider business mailing address

PO BOX 1133
PALMER AK
99645-1133
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-4263
  • Fax:
Mailing address:
  • Phone: 907-746-4263
  • Fax: 907-917-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH MICHAEL SULLIVAN
Title or Position: OWNER
Credential: DC
Phone: 720-308-2307