Healthcare Provider Details

I. General information

NPI: 1356983894
Provider Name (Legal Business Name): BYRON OHARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 E WOODFIELD RD
SCHAUMBURG IL
60173-4706
US

IV. Provider business mailing address

1037 E WOODFIELD RD
SCHAUMBURG IL
60173-4706
US

V. Phone/Fax

Practice location:
  • Phone: 847-519-7046
  • Fax:
Mailing address:
  • Phone: 847-519-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: