Provider Demographics
NPI:1861417370
Name:SULLIVAN, DANIEL PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PATRICK
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 1:811 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4202
Mailing Address - Country:US
Mailing Address - Phone:626-960-5096
Mailing Address - Fax:626-814-8630
Practice Address - Street 1:811 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4202
Practice Address - Country:US
Practice Address - Phone:626-960-5096
Practice Address - Fax:626-814-8630
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor