Healthcare Provider Details

I. General information

NPI: 1609192970
Provider Name (Legal Business Name): JERRILYN N SULLIVAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 BRIDGE ST
NASHUA NH
03060-3576
US

IV. Provider business mailing address

46 BRIDGE ST
NASHUA NH
03060-3576
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-7769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number1120493
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1120493
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: