Provider Demographics
NPI:1962641803
Name:SULLIVAN CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:SULLIVAN CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RODMAN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:502-695-3273
Mailing Address - Street 1:136 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-3240
Mailing Address - Country:US
Mailing Address - Phone:502-695-3273
Mailing Address - Fax:502-695-0906
Practice Address - Street 1:136 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3240
Practice Address - Country:US
Practice Address - Phone:502-695-3273
Practice Address - Fax:502-695-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty