Provider Demographics
NPI:1164616587
Name:O'CONNOR, JOAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 SW CANYON LN STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3451
Mailing Address - Country:US
Mailing Address - Phone:971-348-3710
Mailing Address - Fax:971-348-3711
Practice Address - Street 1:8835 SW CANYON LN STE 120
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3451
Practice Address - Country:US
Practice Address - Phone:971-348-3710
Practice Address - Fax:971-348-3711
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006 0001154111N00000X
OR3066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
472685OtherTUFTS HEALTH PLAN
472685OtherTUFTS
VT8328214OtherCIGNA
VT00068702OtherBCBSVT
VTUVN3721Medicaid
054008921VT01OtherANTHEM
472685OtherTUFTS
054008921VT01OtherANTHEM