Provider Demographics
NPI:1508997602
Name:OCONNOR, KATHRYN A (DC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:OCONNOR
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 1:5 KELLER ST
Mailing Address - Street 2:STE. C
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2349
Mailing Address - Country:US
Mailing Address - Phone:707-778-1145
Mailing Address - Fax:707-778-3506
Practice Address - Street 1:5 KELLER ST
Practice Address - Street 2:STE. C
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2349
Practice Address - Country:US
Practice Address - Phone:707-778-1145
Practice Address - Fax:707-778-3506
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U58131Medicare UPIN
CADC0236730Medicare PIN