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General NPI Number Information
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NPI Number | 1609192970
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Entity Type | Individual
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Provider Name | JERRILYN N SULLIVAN D.C.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 46 BRIDGE ST
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City | NASHUA
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State | NH
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Zip | 03060-3576
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Country | US
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Telephone | 603-882-7769
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Fax |
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Provider Business Mailing Address
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Address Line | 46 BRIDGE ST
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City | NASHUA
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State | NH
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Zip | 03060-3576
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Country | US
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Telephone |
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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 | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | 1120493
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 1120493
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License Number State | NH
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