Provider Demographics
NPI:1548408818
Name:SULLIVAN, DAVID BRICE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRICE
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 1:856 CENTURY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4505
Mailing Address - Country:US
Mailing Address - Phone:717-697-0589
Mailing Address - Fax:717-697-1700
Practice Address - Street 1:856 CENTURY DR
Practice Address - Street 2:SUITE C
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4505
Practice Address - Country:US
Practice Address - Phone:717-697-0589
Practice Address - Fax:717-697-1700
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC10065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor