Provider Demographics
NPI:1790840205
Name:O'BRIEN, KEVIN M (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:O'BRIEN
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 1:18 TOWN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-8001
Mailing Address - Country:US
Mailing Address - Phone:828-321-2173
Mailing Address - Fax:828-321-2173
Practice Address - Street 1:18 TOWN BRANCH RD
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901-8001
Practice Address - Country:US
Practice Address - Phone:828-321-2173
Practice Address - Fax:828-321-2173
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1837111N00000X
SC1530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5092103OtherAETNA
085RHOtherCNC-BCBS
NC0867BOtherNC STATE HEALTH PLAN
NC89085RHMedicaid
5092103OtherAETNA
NC89085RHMedicaid