Provider Demographics
NPI:1003467804
Name:O'MARA, DINO GERALD (DC)
Entity Type:Individual
Prefix:DR
First Name:DINO
Middle Name:GERALD
Last Name:O'MARA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19600 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9321
Mailing Address - Country:US
Mailing Address - Phone:708-478-3000
Mailing Address - Fax:708-478-3007
Practice Address - Street 1:19600 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9321
Practice Address - Country:US
Practice Address - Phone:708-478-3000
Practice Address - Fax:708-478-3007
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor