Healthcare Provider Details

I. General information

NPI: 1992802276
Provider Name (Legal Business Name): SULLIVAN CHIROPRACTIC CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 5TH AVE
NORTH VERSAILLES PA
15137-2319
US

IV. Provider business mailing address

3441 5TH AVE
NORTH VERSAILLES PA
15137-2319
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-4477
  • Fax: 412-664-7913
Mailing address:
  • Phone: 412-664-4477
  • Fax: 412-664-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC002865L
License Number StatePA

VIII. Authorized Official

Name: DR. ANTHONY JAMES SULLIVAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 412-664-4477