Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH13104 | FL |
NPI | 1003410317 |
---|---|
Provider Name | Sarah Sullivan |
First Address | Palm Harbor, FL 34685-2600 |
Second Address | Palm Harbor, FL 34685-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2020 |
Last Update Date | 27/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH13104 | CASH ONLY SERVICE (01) | FL |