Provider Demographics
NPI:1942394465
Name:O'CONNOR, KIMBERLY ROSALINE (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ROSALINE
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 1:3669 SHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1643
Mailing Address - Country:US
Mailing Address - Phone:516-731-3543
Mailing Address - Fax:
Practice Address - Street 1:125 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4905
Practice Address - Country:US
Practice Address - Phone:516-935-3555
Practice Address - Fax:516-935-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7B251Medicare ID - Type Unspecified