Provider Demographics
NPI:1235229097
Name:O'HARA, DENNIS P (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:O'HARA
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 1:14290 SULLYFIELD CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-378-0908
Mailing Address - Fax:703-378-0208
Practice Address - Street 1:14290 SULLYFIELD CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-378-0908
Practice Address - Fax:703-378-0208
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO9292111N00000X
VA0104001121111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC4M151Medicare PIN