Provider Demographics
NPI:1679767107
Name:O'CONNOR SPORTS & SPINE CHIROPRACTIC P.L.L.C.
Entity Type:Organization
Organization Name:O'CONNOR SPORTS & SPINE CHIROPRACTIC P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-370-0074
Mailing Address - Street 1:1274 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7450
Mailing Address - Country:US
Mailing Address - Phone:718-370-0074
Mailing Address - Fax:718-948-1065
Practice Address - Street 1:1274 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7450
Practice Address - Country:US
Practice Address - Phone:718-370-0074
Practice Address - Fax:718-948-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010462111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1048657OtherCIGNA
NY11303OtherMAGNACARE
NYC10462-2 BOtherWORKERS COMPENSATION BOAR
NY5897528OtherGHI
NY837410OtherMPN
NY02882039Medicaid
NY884228OtherHEALTHNET
NY662954OtherACN GROUP
NYOCO462OtherATLANTIS
NYP3175411OtherOXFORD
NY1048657OtherASHN
NYP-12039392OtherMULTIPLAN
NYOCO462OtherATLANTIS
NY02882039Medicaid