Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | NY07349 | NY |
NPI | 1700934361 |
---|---|
Provider Name | Dr. Edward Sullivan |
First Address | Canandaigua, NY 14424-1155 |
Second Address | Canandaigua, NY 14424-1155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30710 | (02) | NY |