Provider Demographics
NPI:1629401476
Name:KEVIN J O'BRIEN DC
Entity Type:Organization
Organization Name:KEVIN J O'BRIEN DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC PA
Authorized Official - Phone:281-812-4009
Mailing Address - Street 1:6312 FM 1960 RD E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2718
Mailing Address - Country:US
Mailing Address - Phone:281-812-4009
Mailing Address - Fax:281-812-4035
Practice Address - Street 1:6312 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2718
Practice Address - Country:US
Practice Address - Phone:281-812-4009
Practice Address - Fax:281-812-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00109HMedicare PIN
TXU91513Medicare UPIN