Provider Demographics
NPI:1073078580
Name:SULLIVAN, LAUREN M (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:M
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 1:305 S KIPLING ST STE C2
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2700
Mailing Address - Country:US
Mailing Address - Phone:720-421-8792
Mailing Address - Fax:303-648-5611
Practice Address - Street 1:305 S KIPLING ST STE C2
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2700
Practice Address - Country:US
Practice Address - Phone:720-421-8792
Practice Address - Fax:303-648-5611
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor