Provider Demographics
NPI:1710258397
Name:DENNIS MICHAEL SULLIVAN, D.C.
Entity Type:Organization
Organization Name:DENNIS MICHAEL SULLIVAN, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-709-8946
Mailing Address - Street 1:2305 SE WASHINGTON ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7647
Mailing Address - Country:US
Mailing Address - Phone:503-709-8946
Mailing Address - Fax:503-659-4445
Practice Address - Street 1:2305 SE WASHINGTON ST STE 109
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7647
Practice Address - Country:US
Practice Address - Phone:503-709-8946
Practice Address - Fax:503-659-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073552873OtherNPI TYPE 1