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General NPI Number Information
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NPI Number | 1285004978
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Entity Type | Organization
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Legal Business Name | M. SULLIVAN CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 728 W. DOUGLAS AVE
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City | WICHITA
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State | KS
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Zip | 67203
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Country | UM
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Telephone | 316-267-2555
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Fax | 316-267-2554
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Provider Business Mailing Address
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Address Line | 728 W DOUGLAS AVE
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City | WICHITA
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State | KS
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Zip | 67203-6104
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Country | US
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Telephone | 316-267-2555
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Fax | 316-267-2554
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEGAN SULLIVAN
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Credential | D.C.
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Telephone | 785-214-2514
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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 | 0105658
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License Number State | KS
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