Provider Demographics
NPI:1578642138
Name:SULLIVAN, JOSEPH C III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:SULLIVAN
Suffix:III
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 1:175 ROUTE 25A STE 5
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2947
Mailing Address - Country:US
Mailing Address - Phone:631-702-5115
Mailing Address - Fax:
Practice Address - Street 1:17 LEONARD ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1015
Practice Address - Country:US
Practice Address - Phone:917-655-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18970111N00000X
NYX011979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty