Provider Demographics
NPI:1407596976
Name:O'NEILL, WILLIAM JOHN RUSSELL (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM JOHN RUSSELL
Middle Name:
Last Name:O'NEILL
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 1:5228 ALBERTA FALLS ST
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-5807
Mailing Address - Country:US
Mailing Address - Phone:970-372-8804
Mailing Address - Fax:
Practice Address - Street 1:1587 TAURUS COURT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537
Practice Address - Country:US
Practice Address - Phone:970-430-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0002264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty