Individual
DR. TIMOTHY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
11339 GRAVOIS RD, SAINT LOUIS, MO 63126-3623
(314) 842-1616
Mailing address
6028 WELDON SPRING PKWY, WELDON SPRING, MO 63304-9103
(330) 968-8085
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2016000617
MO
Other
Enumeration date
12/16/2015
Last updated
10/19/2017
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