Provider Demographics
NPI:1114688140
Name:SULLIVAN, HEIDI LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LYNN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:MOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1440 SILVER PINE LN
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-1394
Mailing Address - Country:US
Mailing Address - Phone:320-808-7980
Mailing Address - Fax:
Practice Address - Street 1:11405 N PENNSYLVANIA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6942
Practice Address - Country:US
Practice Address - Phone:320-808-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003274A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor