River'S Edge Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4186 Issued in OH

Legal business name

RIVER'S EDGE CHIROPRACTIC LLC

Practice address

701 Beta Dr
Suite 18
Mayfield Village, OH 44143-2367

Phone

(440) 459-1414

Fax

(440) 459-1347

NPI assigned

Sep 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Sullivan, DCNPI 1063793933

Title

Chiropractor / Owner

Phone

(440) 459-1414

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Edward Sullivan Jr., D.C.

  • Chiropractor
  • Mayfield Village, OH
  • NPI 1063793933
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481241600000",
    "number": "1699223966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 BETA DR",
            "address_2": "SUITE 18",
            "city": "MAYFIELD VILLAGE",
            "state": "OH",
            "postal_code": "441432367",
            "telephone_number": "440-459-1414",
            "fax_number": "440-459-1347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 BETA DR",
            "address_2": "SUITE 18",
            "city": "MAYFIELD VILLAGE",
            "state": "OH",
            "postal_code": "441432367",
            "telephone_number": "440-459-1414",
            "fax_number": "440-459-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER'S EDGE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-15",
        "last_updated": "2016-12-09",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CHIROPRACTOR / OWNER",
        "authorized_official_telephone_number": "440-459-1414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "4186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Mayfield Village, OH
• Providers in Mayfield Village, OH by specialty
• Chiropractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.