Provider Demographics
NPI:1326369224
Name:O'GRADY, SEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:O'GRADY
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 1:177 BOVET RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3116
Mailing Address - Country:US
Mailing Address - Phone:650-375-2545
Mailing Address - Fax:650-655-6611
Practice Address - Street 1:177 BOVET RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3116
Practice Address - Country:US
Practice Address - Phone:650-375-2545
Practice Address - Fax:650-655-6611
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherTAX IDENTIFICATION NUMBER