Provider Demographics
NPI:1902865496
Name:SULLIVAN, JAMES ALLAN (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLAN
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 1:2699 JOHN F KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2838
Mailing Address - Country:US
Mailing Address - Phone:563-556-8600
Mailing Address - Fax:563-556-8600
Practice Address - Street 1:2699 JOHN F KENNEDY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2838
Practice Address - Country:US
Practice Address - Phone:563-556-8600
Practice Address - Fax:563-556-8600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28866OtherBLUE CROSS BLUE SHIELD
IA0288662Medicaid
IAI16441Medicare ID - Type Unspecified
IA0288662Medicaid