MEDICARE: DR. GERARD EDWARD SULLIVAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00001104	WA

General Provider Information

NPI Number	:	1942205828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD EDWARD SULLIVAN D.C.

Provider Business Mailing Address
First Line	:	4401 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4201
Country	:	US
Telephone Number	:	253-564-9424
Fax Number	:	253-564-9721

Provider Business Practice Location Address
First Line	:	4401 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4201
Country	:	US
Telephone Number	:	253-564-9424
Fax Number	:	253-564-9721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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