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General NPI Number Information
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NPI Number | 1003410317
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Entity Type | Individual
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Provider Name | SARAH SULLIVAN DC
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Gender | Female
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Dates
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Enumeration Date | 11/27/2020
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 1321 SE US HIGHWAY 19 STE B
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4821
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Country | US
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Telephone | 352-340-2895
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Fax |
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Provider Business Mailing Address
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Address Line | 1622 S WALLACE PT
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-8580
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Country | US
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Telephone | 352-340-2895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH13104
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License Number State | FL
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