Provider Demographics
NPI:1164492807
Name:SULLIVAN, DOUGLAS EARLE (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EARLE
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 RUFE SNOW DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6684
Mailing Address - Country:US
Mailing Address - Phone:817-656-4330
Mailing Address - Fax:817-498-4457
Practice Address - Street 1:5424 RUFE SNOW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-656-4330
Practice Address - Fax:817-498-4457
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U75324Medicare UPIN
TX8350B0Medicare ID - Type Unspecified