Provider Demographics
NPI:1235666439
Name:O'SULLIVAN FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:O'SULLIVAN FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-378-1515
Mailing Address - Street 1:214 BLAIRS FERRY RD NE STE 2
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1602
Mailing Address - Country:US
Mailing Address - Phone:319-331-8634
Mailing Address - Fax:319-378-9292
Practice Address - Street 1:214 BLAIRS FERRY RD NE STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1602
Practice Address - Country:US
Practice Address - Phone:319-331-8634
Practice Address - Fax:319-378-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty