Active NPI
Charles Bret Sullivan, DC
- Chiropractor
- Marina, CA
National Provider Identifier
1811086069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 770014679
- Practice address
- 201 9TH Street
Marina, CA 93933 - Phone
- (831) 884-1000
- Fax
- (559) 227-7701
- NPI assigned
- Oct 12, 2006
- Last updated
- Jul 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 770014679 | CA | Primary |
Addresses
Primary practice location
201 9TH Street
Marina, CA 93933
Mailing address
P.O. Box 51220
Pacific Grove, CA 93950
Phone (559) 907-3400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15406 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658102400000",
"number": "1811086069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 51220",
"city": "PACIFIC GROVE",
"state": "CA",
"postal_code": "93950",
"telephone_number": "559-907-3400",
"fax_number": "831-603-5303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 9TH STREET",
"city": "MARINA",
"state": "CA",
"postal_code": "93933",
"telephone_number": "831-884-1000",
"fax_number": "559-227-7701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "CHARLES",
"middle_name": "BRET",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2022-07-18",
"certification_date": "2022-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "770014679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.