Provider Demographics
NPI:1518303163
Name:O'SULLIVAN, AMANDA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JO
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BLAIRS FERRY RD NE STE 2
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1602
Mailing Address - Country:US
Mailing Address - Phone:319-378-1515
Mailing Address - Fax:319-378-9292
Practice Address - Street 1:214 BLAIRS FERRY RD NE STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1602
Practice Address - Country:US
Practice Address - Phone:319-378-1515
Practice Address - Fax:319-378-9292
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor