Healthcare Provider Details

I. General information

NPI: 1154752392
Provider Name (Legal Business Name): MAIN STREET CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 MAIN ST
NASHUA NH
03060-5046
US

IV. Provider business mailing address

382 MAIN ST
NASHUA NH
03060-5046
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-5742
  • Fax:
Mailing address:
  • Phone: 603-882-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1120493
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JERRILYN N SULLIVAN
Title or Position: OWNER
Credential:
Phone: 603-882-5742