Provider Demographics
NPI:1710317359
Name:SULLIVAN CHIROPRACTIC
Entity Type:Organization
Organization Name:SULLIVAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SULLLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-718-4102
Mailing Address - Street 1:10980 SYCAMORE CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8021
Mailing Address - Country:US
Mailing Address - Phone:530-718-4102
Mailing Address - Fax:
Practice Address - Street 1:10055 WOLF RD STE 4
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-8148
Practice Address - Country:US
Practice Address - Phone:530-718-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty