Provider Demographics
NPI:1013105832
Name:O'CONNOR, BARRY KEVIN (DC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:KEVIN
Last Name:O'CONNOR
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 1:12250 LA MIRADA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1306
Mailing Address - Country:US
Mailing Address - Phone:562-943-0141
Mailing Address - Fax:562-947-7246
Practice Address - Street 1:12250 LA MIRADA BLVD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1306
Practice Address - Country:US
Practice Address - Phone:562-943-0141
Practice Address - Fax:562-947-7246
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC015005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17951Medicare UPIN