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General NPI Number Information
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NPI Number | 1982019840
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Entity Type | Individual
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Provider Name | TIMOTHY PAUL SULLIVAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 17000 E US HIGHWAY 40 STE 7
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City | INDEPENDENCE
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State | MO
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Zip | 64055-5394
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Country | US
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Telephone | 816-373-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 3506 HARVARD AVE
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City | INDEPENDENCE
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State | MO
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Zip | 64052-2337
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Country | US
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Telephone | 402-490-7509
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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 | 2014013450
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License Number State | MO
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