MEDICARE: SULLIVAN CHIROPRACTIC CLINIC, P.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	DC002865L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992802276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULLIVAN CHIROPRACTIC CLINIC, P.C.

Provider Business Mailing Address
First Line	:	3441 5TH AVE
Second Line	:
City	:	NORTH VERSAILLES
State	:	PA
Zip	:	15137-2319
Country	:	US
Telephone Number	:	412-664-4477
Fax Number	:	412-664-7913

Provider Business Practice Location Address
First Line	:	3441 5TH AVE
Second Line	:
City	:	NORTH VERSAILLES
State	:	PA
Zip	:	15137-2319
Country	:	US
Telephone Number	:	412-664-4477
Fax Number	:	412-664-7913

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY JAMES SULLIVAN
Credential	:	D.C.
Telephone Number	:	412-664-4477

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/06/2007

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