Healthcare Provider Details

I. General information

NPI: 1396720835
Provider Name (Legal Business Name): ANGELA L SULLIVAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA L DAGHESTANIAN D.C.

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COLUMBIA POINT DR
RICHLAND WA
99352-4387
US

IV. Provider business mailing address

110 COLUMBIA POINT DR
RICHLAND WA
99352-4387
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-7692
  • Fax: 509-943-8639
Mailing address:
  • Phone: 509-946-7692
  • Fax: 509-943-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: