Provider Demographics
NPI:1285004978
Name:M. SULLIVAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:M. SULLIVAN CHIROPRACTIC LLC
Other - Org Name:HEALING HANDS FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-214-2514
Mailing Address - Street 1:728 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-6104
Mailing Address - Country:US
Mailing Address - Phone:316-267-2555
Mailing Address - Fax:316-267-2554
Practice Address - Street 1:728 W. DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203
Practice Address - Country:UM
Practice Address - Phone:316-267-2555
Practice Address - Fax:316-267-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty