Provider Demographics
NPI:1306947338
Name:SULLIVAN, BRIAN A (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
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 1:101 BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6100
Mailing Address - Country:US
Mailing Address - Phone:540-667-0220
Mailing Address - Fax:540-667-6022
Practice Address - Street 1:101 BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-6100
Practice Address - Country:US
Practice Address - Phone:540-667-0220
Practice Address - Fax:540-667-6022
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor