Provider Demographics
NPI:1326118969
Name:SULLIVAN-NIELSEN, PATRICIA A (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:SULLIVAN-NIELSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TREEKA
Other - Middle Name:A
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2490 E 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5206
Mailing Address - Country:US
Mailing Address - Phone:907-561-4325
Mailing Address - Fax:907-561-8323
Practice Address - Street 1:2490 E 42ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5206
Practice Address - Country:US
Practice Address - Phone:907-561-4325
Practice Address - Fax:907-561-8323
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHO312Medicaid