Provider Demographics
NPI:1750465886
Name:O'CONNOR, MAUREEN PATRICE (DC)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:PATRICE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1044
Mailing Address - Country:US
Mailing Address - Phone:920-846-8200
Mailing Address - Fax:920-490-9698
Practice Address - Street 1:515 S MILITARY AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2209
Practice Address - Country:US
Practice Address - Phone:920-490-0200
Practice Address - Fax:920-490-9698
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38882900Medicaid
WI38882900Medicaid
WI70734Medicare ID - Type Unspecified