Provider Demographics
NPI:1093035537
Name:O'LEARY, DANIEL KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KENNETH
Last Name:O'LEARY
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 1:1550 HENDRICKS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3108
Mailing Address - Country:US
Mailing Address - Phone:904-909-7455
Mailing Address - Fax:
Practice Address - Street 1:1550 HENDRICKS AVE STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3108
Practice Address - Country:US
Practice Address - Phone:904-503-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor