Healthcare Provider Details

I. General information

NPI: 1720905904
Provider Name (Legal Business Name): JACKSON MATTHEW O'CONNOR DC, DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16905 NORTHCROSS DR
HUNTERSVILLE NC
28078-5012
US

IV. Provider business mailing address

10916 NORTHLAKE LANDING DR APT 7204
CHARLOTTE NC
28216-0216
US

V. Phone/Fax

Practice location:
  • Phone: 704-661-0085
  • Fax:
Mailing address:
  • Phone: 704-661-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number6042
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: