Provider Demographics
NPI:1679559488
Name:SULLIVAN, TIMOTHY E (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
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 1:6101 WINDCOM CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7817
Mailing Address - Country:US
Mailing Address - Phone:972-378-9991
Mailing Address - Fax:972-378-9992
Practice Address - Street 1:6101 WINDCOM CT
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7817
Practice Address - Country:US
Practice Address - Phone:972-378-9991
Practice Address - Fax:972-378-9992
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F6101Medicare PIN