Provider Demographics
NPI:1023445327
Name:O'NEILL, COREY (DC)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:O'NEILL
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:PO BOX 5267
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-0051
Mailing Address - Country:US
Mailing Address - Phone:541-601-5062
Mailing Address - Fax:
Practice Address - Street 1:943 AUTOMATION WAY
Practice Address - Street 2:A1
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4192
Practice Address - Country:US
Practice Address - Phone:541-601-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor