Provider Demographics
NPI:1518988138
Name:O'BRIEN, TARA MARIE (DC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MARIE
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 1:2710 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3556
Mailing Address - Country:US
Mailing Address - Phone:516-781-9555
Mailing Address - Fax:516-781-2871
Practice Address - Street 1:2710 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3556
Practice Address - Country:US
Practice Address - Phone:516-781-9555
Practice Address - Fax:516-781-2871
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02711791Medicaid
NY02711791Medicaid