Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3109 | SC |
NPI | 1003856147 |
---|---|
Provider Name | Dr. Shana L Sullivan |
First Address | Greenwood, SC 29649-0019 |
Second Address | Greenwood, SC 29649-9722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |