Provider Demographics
NPI:1497315444
Name:O'CONNOR, PEYTON JAMES
Entity type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:JAMES
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:
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:413-734-7999
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:413-734-7999
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor