Provider Demographics
NPI:1780016642
Name:O'CONNELL PROGRESSIVE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:O'CONNELL PROGRESSIVE CHIROPRACTIC, LLC
Other - Org Name:PROGRESSIVE SPINE AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-641-4800
Mailing Address - Street 1:545 HOOKSETT RD UNIT 20
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2654
Mailing Address - Country:US
Mailing Address - Phone:603-641-4800
Mailing Address - Fax:603-622-3199
Practice Address - Street 1:1850 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2911
Practice Address - Country:US
Practice Address - Phone:603-641-4800
Practice Address - Fax:603-622-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH881111N00000X
NH3046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH306507Medicare PIN
NH0034552Medicare PIN
NH002258503Medicare PIN