Organization
CHIRO-MED & REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH JAMES SULLIVAN-BOL DC (PRESIDENT/ CEO)
(802) 753-7930
Entity
Organization
Contact information
Practice address
345 ELM ST, BENNINGTON, VT 05201-2265
(802) 753-7930
(802) 753-7924
Mailing address
345 ELM ST, BENNINGTON, VT 05201-2265
(802) 753-7930
(802) 753-7924
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
006.0061495
VT
111N00000X
Chiropractor
38-009348
IL
2251X0800X
Orthopedic Physical Therapist
Primary
006.0061495
VT
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020447
—
VT
Enumeration date
04/05/2012
Last updated
04/24/2024
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