Provider Demographics
NPI:1891837027
Name:SULLIVAN CHIROPRACTIC OF CHATHAM, P.C.
Entity Type:Organization
Organization Name:SULLIVAN CHIROPRACTIC OF CHATHAM, P.C.
Other - Org Name:SULLIVAN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:217-483-2207
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:1209 N. MAIN ST., #B
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-0264
Mailing Address - Country:US
Mailing Address - Phone:217-483-2207
Mailing Address - Fax:217-483-3248
Practice Address - Street 1:1209 N. MAIN ST.
Practice Address - Street 2:#B
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-0264
Practice Address - Country:US
Practice Address - Phone:217-483-2207
Practice Address - Fax:217-483-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty