Provider Demographics
NPI:1629098272
Name:O'LEARY, TIMOTHY E (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:O'LEARY
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 1:49 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4375
Mailing Address - Country:US
Mailing Address - Phone:978-531-0202
Mailing Address - Fax:978-532-7076
Practice Address - Street 1:49 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4375
Practice Address - Country:US
Practice Address - Phone:978-531-0202
Practice Address - Fax:978-532-7076
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37137OtherBCBSMA
MAY37137OtherBCBSMA
MAOL-Y45858Medicare ID - Type Unspecified