Provider Demographics
NPI:1558403170
Name:KEISER-O'NEILL, WENDY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ANN
Last Name:KEISER-O'NEILL
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 1:103-12 LLIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1729
Mailing Address - Country:US
Mailing Address - Phone:718-845-7200
Mailing Address - Fax:718-322-5855
Practice Address - Street 1:103-12 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1729
Practice Address - Country:US
Practice Address - Phone:718-845-7200
Practice Address - Fax:718-322-5855
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO6775111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU55959Medicare UPIN
NY01580Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER