Provider Demographics
NPI:1417028671
Name:O'CONNOR, TIMOTHY J (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:O'CONNOR
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 1:4914 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2921
Mailing Address - Country:US
Mailing Address - Phone:770-667-0099
Mailing Address - Fax:770-667-0092
Practice Address - Street 1:4914 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-2921
Practice Address - Country:US
Practice Address - Phone:770-667-0099
Practice Address - Fax:770-667-0092
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP0089594OtherRAILROAD MR
861037341OtherTIN
Z127417Medicare PIN