Provider Demographics
NPI:1811399413
Name:SULLIVAN, MEGAN R (DC)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:R
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 1:360 S ALL HALLOWS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2438
Mailing Address - Country:US
Mailing Address - Phone:785-214-2514
Mailing Address - Fax:316-201-4331
Practice Address - Street 1:278 W. DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-6104
Practice Address - Country:US
Practice Address - Phone:316-267-2555
Practice Address - Fax:316-267-2554
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor