Provider Demographics
NPI:1023237682
Name:SULLIVAN, DAN (DC)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
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 1:1245 TRIMBLE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1290
Mailing Address - Country:US
Mailing Address - Phone:402-450-8750
Mailing Address - Fax:
Practice Address - Street 1:1600 NORMANDY CT
Practice Address - Street 2:STE. 110
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1470
Practice Address - Country:US
Practice Address - Phone:402-423-4422
Practice Address - Fax:402-423-4414
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor