Provider Demographics
NPI:1740369982
Name:SULLIVAN FAMILY CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:SULLIVAN FAMILY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-547-1800
Mailing Address - Street 1:2315 W ARBORS DR STE 208A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2577
Mailing Address - Country:US
Mailing Address - Phone:704-547-1800
Mailing Address - Fax:704-547-1611
Practice Address - Street 1:2315 W ARBORS DR STE 208A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2577
Practice Address - Country:US
Practice Address - Phone:704-547-1800
Practice Address - Fax:704-547-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890844XMedicaid
NC2455484Medicare ID - Type Unspecified
NC890844XMedicaid