Provider Demographics
NPI:1679089007
Name:O'CONNELL, CORY (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:O'CONNELL
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 1:61 CRESCENT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1400
Mailing Address - Country:US
Mailing Address - Phone:201-444-1988
Mailing Address - Fax:201-444-8709
Practice Address - Street 1:61 CRESCENT AVE STE B
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1400
Practice Address - Country:US
Practice Address - Phone:201-444-1988
Practice Address - Fax:201-444-8709
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00736100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor