Provider Demographics
NPI:1003856147
Name:SULLIVAN, SHANA L (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50091
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0019
Mailing Address - Country:US
Mailing Address - Phone:864-223-2236
Mailing Address - Fax:864-223-2246
Practice Address - Street 1:2410 HWY 72 221 E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-9722
Practice Address - Country:US
Practice Address - Phone:864-223-2236
Practice Address - Fax:864-223-2246
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor