Provider Demographics
NPI:1093883829
Name:O'BRIANT, KEVIN HORTON (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HORTON
Last Name:O'BRIANT
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 1:1986 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9336
Mailing Address - Country:US
Mailing Address - Phone:919-570-6511
Mailing Address - Fax:919-570-8299
Practice Address - Street 1:1986 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9336
Practice Address - Country:US
Practice Address - Phone:919-570-6511
Practice Address - Fax:919-570-8299
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908437Medicaid
NC2454010Medicare ID - Type Unspecified