Provider Demographics
NPI:1497792535
Name:SULLIVAN, ARNO EUGENE (D,C,)
Entity Type:Individual
Prefix:DR
First Name:ARNO
Middle Name:EUGENE
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95665-0609
Mailing Address - Country:US
Mailing Address - Phone:209-269-5755
Mailing Address - Fax:209-296-4493
Practice Address - Street 1:20104 HWY 88
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:CA
Practice Address - Zip Code:95665
Practice Address - Country:US
Practice Address - Phone:209-296-5755
Practice Address - Fax:209-296-4493
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA14509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0145090Medicare ID - Type UnspecifiedMEDICARE PROVIDE NUMBER