Provider Demographics
NPI:1134258551
Name:SULLIVAN, JOHN N (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
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 1:15030 IMPERIAL HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1301
Mailing Address - Country:US
Mailing Address - Phone:562-943-5585
Mailing Address - Fax:562-943-4423
Practice Address - Street 1:15030 IMPERIAL HWY
Practice Address - Street 2:SUITE A
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1301
Practice Address - Country:US
Practice Address - Phone:562-943-5585
Practice Address - Fax:562-943-4423
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13469Medicare ID - Type Unspecified