Provider Demographics
NPI:1336682418
Name:SULLIVAN, JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
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 1:12151 E PALMER WASILLA HWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8880
Mailing Address - Country:US
Mailing Address - Phone:907-746-4263
Mailing Address - Fax:907-917-5453
Practice Address - Street 1:12151 E PALMER WASILLA HWY UNIT B
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8880
Practice Address - Country:US
Practice Address - Phone:907-746-4263
Practice Address - Fax:907-917-5453
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR0007282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK142024OtherSTATE OF ALASKA