Healthcare Provider Details

I. General information

NPI: 1275527178
Provider Name (Legal Business Name): JAMES R SULLIVAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 06/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W STATE ST
FRANKFORT KY
40601-3419
US

IV. Provider business mailing address

120 W STATE ST
FRANKFORT KY
40601-3419
US

V. Phone/Fax

Practice location:
  • Phone: 502-330-0036
  • Fax:
Mailing address:
  • Phone: 502-330-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3823
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: