Provider Demographics
NPI:1598852410
Name:O'BRIEN, JOSEPH M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:O'BRIEN
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 1:191 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5008
Mailing Address - Country:US
Mailing Address - Phone:845-369-7611
Mailing Address - Fax:
Practice Address - Street 1:191 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5008
Practice Address - Country:US
Practice Address - Phone:845-369-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009128111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU73262Medicare UPIN
NYX4B381Medicare ID - Type Unspecified