Provider Demographics
NPI:1477832194
Name:O'HARA, JEFFREY GANNON (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GANNON
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 1:1180 MAIN ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4753
Mailing Address - Country:US
Mailing Address - Phone:970-744-1084
Mailing Address - Fax:
Practice Address - Street 1:1180 MAIN ST UNIT 7
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4753
Practice Address - Country:US
Practice Address - Phone:970-744-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR6717111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCHR6717OtherCHR6717