Provider Demographics
NPI:1396720835
Name:SULLIVAN, ANGELA L (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:DAGHESTANIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:110 COLUMBIA POINT DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4387
Mailing Address - Country:US
Mailing Address - Phone:509-946-7692
Mailing Address - Fax:509-943-8639
Practice Address - Street 1:110 COLUMBIA POINT DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4387
Practice Address - Country:US
Practice Address - Phone:509-946-7692
Practice Address - Fax:509-943-8639
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH00034466OtherSTATE LICENSE
WACH00034466OtherSTATE LICENSE
WAG8857736Medicare PIN