Provider Demographics
NPI:1760698658
Name:MCKENNA, OHARA LORRAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:OHARA
Middle Name:LORRAINE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:OHARA
Other - Middle Name:LORRAINE
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2111 W SWANN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2477
Mailing Address - Country:US
Mailing Address - Phone:813-253-5969
Mailing Address - Fax:813-253-5848
Practice Address - Street 1:2111 W SWANN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2477
Practice Address - Country:US
Practice Address - Phone:813-253-5969
Practice Address - Fax:813-253-5848
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor