Provider Demographics
NPI:1659575165
Name:O'HARE, DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:O'HARE
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 1:1319 THE PLZ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3427
Mailing Address - Country:US
Mailing Address - Phone:704-375-3218
Mailing Address - Fax:704-334-7059
Practice Address - Street 1:1319 THE PLZ
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3427
Practice Address - Country:US
Practice Address - Phone:704-375-3218
Practice Address - Fax:704-334-7059
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908688Medicaid
NC086922Medicare ID - Type Unspecified