Provider Demographics
NPI:1396803300
Name:O'CONNOR, MICHAEL J (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
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 1:1387 CAREW ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2123
Mailing Address - Country:US
Mailing Address - Phone:413-732-1201
Mailing Address - Fax:
Practice Address - Street 1:1387 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2123
Practice Address - Country:US
Practice Address - Phone:413-732-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1609467Medicaid
MA043082314OtherCIGNA HEALTHCARE
MAY36020OtherBCBS INDIVIDUAL
MA043082314OtherACN GROUP
MA4514819OtherAETNA
MAY39942OtherBCBS GROUP
MA616541OtherTUFTS
MA793708OtherSECURE HORIZON
MA043082314OtherACN GROUP
MA043082314OtherCIGNA HEALTHCARE