Provider Demographics
NPI:1740344324
Name:O'NEILL, KERRY J (DC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:J
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 1:203 14TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5223
Mailing Address - Country:US
Mailing Address - Phone:206-381-3473
Mailing Address - Fax:206-388-0913
Practice Address - Street 1:203 14TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5223
Practice Address - Country:US
Practice Address - Phone:206-381-3473
Practice Address - Fax:206-388-0913
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH2928111N00000X
LALA1189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor