Provider Demographics
NPI:1518180454
Name:IVEY-OSULLIVAN HEALTHCARE SERVICES, PA
Entity Type:Organization
Organization Name:IVEY-OSULLIVAN HEALTHCARE SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:OSULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-583-3967
Mailing Address - Street 1:201 S DEAN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1968
Mailing Address - Country:US
Mailing Address - Phone:864-583-3967
Mailing Address - Fax:864-585-5554
Practice Address - Street 1:201 S DEAN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1968
Practice Address - Country:US
Practice Address - Phone:864-583-3967
Practice Address - Fax:864-585-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty