Provider Demographics
NPI:1245377845
Name:SULLIVAN, TERESA ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANNE
Last Name:SULLIVAN
Suffix:
Gender:F
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:PO BOX 183
Mailing Address - Street 2:32993 S 69 HWY
Mailing Address - City:BIG CABIN
Mailing Address - State:OK
Mailing Address - Zip Code:74332-0183
Mailing Address - Country:US
Mailing Address - Phone:918-783-5000
Mailing Address - Fax:918-783-5005
Practice Address - Street 1:32993 S 69 HWY
Practice Address - Street 2:
Practice Address - City:BIG CABIN
Practice Address - State:OK
Practice Address - Zip Code:74332
Practice Address - Country:US
Practice Address - Phone:918-783-5000
Practice Address - Fax:918-783-5005
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK#3179111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist