Provider Demographics
NPI:1235119959
Name:SULLIVAN, TODD PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:PATRICK
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 1:5288 LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1688
Mailing Address - Country:US
Mailing Address - Phone:703-912-7822
Mailing Address - Fax:
Practice Address - Street 1:5288 LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1688
Practice Address - Country:US
Practice Address - Phone:703-912-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45819Medicare ID - Type UnspecifiedMEDICARE NUMBER