Provider Demographics
NPI:1093816712
Name:O'LEARY, PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
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 1:1213 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-1838
Mailing Address - Country:US
Mailing Address - Phone:320-843-4477
Mailing Address - Fax:320-843-4480
Practice Address - Street 1:1213 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1838
Practice Address - Country:US
Practice Address - Phone:320-843-4477
Practice Address - Fax:320-843-4480
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4623231 00Medicaid
MN359000307Medicare ID - Type Unspecified
MN4C141OLMedicare UPIN