Provider Demographics
NPI:1316025331
Name:SULLIVAN, CHRISTOPHER JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAY
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 1:609 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5036
Mailing Address - Country:US
Mailing Address - Phone:607-786-3294
Mailing Address - Fax:607-786-3328
Practice Address - Street 1:609 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5036
Practice Address - Country:US
Practice Address - Phone:607-786-3294
Practice Address - Fax:607-786-3328
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor