DR. JIMMY BRIAN SULLIVAN (NPI# 1619368941) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619368941 |
| Entity Type | Individual |
| Full Name | DR. JIMMY BRIAN SULLIVAN |
| Credential | DC |
| Practice Address |
621 Shelley Park Plz Tyler TX 75701-9457 |
| Practice Telephone | (903) 597-9021 |
| Mailing Telephone | (903) 597-9021 |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2017-07-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 12808 | TX | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | MEDICARE | 583300AC3Z | 01 |
| Street Address |
621 SHELLEY PARK PLZ |
| City | TYLER |
| State | TX |
| Zip Code | 75701-9457 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619497401 | Four-ten Enterprise, LLC | Chiropractor | 621 Shelley Park Plz, Tyler, TX 75701-9457 | 2017-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1962988402 | Blake Danton Carroll | Chiropractor | 6573 Old Jacksonville Hwy Ste 100, Tyler, TX 75703-0722 | 2018-07-18 |
| 1689180259 | Align Family Chiropractic LLC | Chiropractor | 117 W Hughes Street, Tyler, MN 56178 | 2017-12-19 |
| 1053840553 | Jennifer Golden | Chiropractor | 5348 Old Jacksonville Hwy Apt 1312, Tyler, TX 75703-3366 | 2017-06-08 |
| 1457895237 | William Chad Adcock | Chiropractor | 5524 Old Jacksonville Hwy, Tyler, TX 75703-3378 | 2016-12-13 |
| 1962861138 | Erik Malone | Chiropractor | 140 E 9th St, Tyler, TX 75701-4227 | 2016-02-17 |
| 1487023743 | Tiffany Sarmiento | Chiropractor | 3526 S Broadway Ave, Tyler, TX 75701-8707 | 2015-09-16 |
| 1285041087 | James Gardner | Chiropractor | 3316 Woods Blvd, Tyler, TX 75707-1656 | 2014-07-14 |
| 1326466046 | Hendricks Chiropractic, P.a. | Chiropractor | 1213 Doctors Dr., Hendricks Chiropractic P.a., Tyler, TX 75701 | 2014-03-31 |
| 1861777526 | Jk7 Promisland, Inc. | Chiropractor | 6775 Old Jacksonville Hwy # 2, Tyler, TX 75703-0508 | 2011-10-13 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.