Healthcare Provider Details

I. General information

NPI: 1437080371
Provider Name (Legal Business Name): JOSHUA SCOTT SULLIVAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 HIGHWAY 21 STE 103
FORT MILL SC
29715-7206
US

IV. Provider business mailing address

3071 HIGHWAY 21 STE 103
FORT MILL SC
29715-7206
US

V. Phone/Fax

Practice location:
  • Phone: 803-835-0444
  • Fax:
Mailing address:
  • Phone: 803-835-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5312
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: