Provider Demographics
NPI:1780630517
Name:O'SULLIVAN, GENE JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:JOHN
Last Name:O'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 1:114 POPLAR ALY
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-6202
Mailing Address - Country:US
Mailing Address - Phone:724-238-3922
Mailing Address - Fax:724-238-9211
Practice Address - Street 1:114 POPLAR ALY
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-6202
Practice Address - Country:US
Practice Address - Phone:724-238-3922
Practice Address - Fax:724-238-9211
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93825Medicare UPIN
066913Medicare ID - Type Unspecified