Provider Demographics
NPI:1386883684
Name:SULLIVAN, RYAN M (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
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 1:8 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1226
Mailing Address - Country:US
Mailing Address - Phone:207-837-6936
Mailing Address - Fax:207-837-6937
Practice Address - Street 1:8 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1226
Practice Address - Country:US
Practice Address - Phone:207-837-6936
Practice Address - Fax:207-837-6937
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor