Healthcare Provider Details

I. General information

NPI: 1891961025
Provider Name (Legal Business Name): DANIEL P SULLIVAN D C A CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S GLENDORA AVE
WEST COVINA CA
91790-4202
US

IV. Provider business mailing address

811 S GLENDORA AVE
WEST COVINA CA
91790-4202
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-5096
  • Fax:
Mailing address:
  • Phone: 626-960-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC17336
License Number StateCA

VIII. Authorized Official

Name: MRS. YASMIN VEGA
Title or Position: MANAGER
Credential:
Phone: 626-960-5096