Provider Demographics
NPI:1336477801
Name:O'BRIEN, JENNIFER R (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:O'BRIEN
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 1:222 SOMBRIO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1540
Mailing Address - Country:US
Mailing Address - Phone:505-986-2870
Mailing Address - Fax:505-986-2871
Practice Address - Street 1:2009 BOTULPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1107
Practice Address - Country:US
Practice Address - Phone:505-986-2870
Practice Address - Fax:505-986-2871
Is Sole Proprietor?:No
Enumeration Date:2009-11-21
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor