Provider Demographics
NPI:1710994033
Name:O'CONNOR, DENNIS E (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:E
Last Name:O'CONNOR
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 1:2 BROOKHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1611
Mailing Address - Country:US
Mailing Address - Phone:781-631-0155
Mailing Address - Fax:781-631-7195
Practice Address - Street 1:2 BROOKHOUSE DR
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-1611
Practice Address - Country:US
Practice Address - Phone:781-631-0155
Practice Address - Fax:781-631-7195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1609246MAMedicaid
MA043151995OtherTAX IDENTIFICATION
MA35216OtherHARVARD PILGRIM HEALTHCAR
MA722352OtherTUFTS HEALTH PLAN
MAOC Y35950OtherBC/BS
MAY35950Medicare ID - Type Unspecified
MA722352OtherTUFTS HEALTH PLAN