Provider Demographics
NPI:1386254084
Name:SULLIVAN, JAMIE L (DC)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
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 1:4657 SHALLOWFORD CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7916
Mailing Address - Country:US
Mailing Address - Phone:615-476-0139
Mailing Address - Fax:
Practice Address - Street 1:4657 SHALLOWFORD CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7916
Practice Address - Country:US
Practice Address - Phone:615-476-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor