Healthcare Provider Details

I. General information

NPI: 1689829012
Provider Name (Legal Business Name): OBRIEN CHIROPRACTIC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 E TOM T HALL BLVD
OLIVE HILL KY
41164-7040
US

IV. Provider business mailing address

775 E TOM T HALL BLVD
OLIVE HILL KY
41164-7040
US

V. Phone/Fax

Practice location:
  • Phone: 606-286-1000
  • Fax: 606-286-0860
Mailing address:
  • Phone: 606-286-1000
  • Fax: 606-286-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5031
License Number StateKY

VIII. Authorized Official

Name: DR. TIMOTHY W OBRIEN
Title or Position: OWNER
Credential: DC
Phone: 606-286-1000