Healthcare Provider Details

I. General information

NPI: 1780016642
Provider Name (Legal Business Name): O'CONNELL PROGRESSIVE CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 ELM ST
MANCHESTER NH
03104-2911
US

IV. Provider business mailing address

545 HOOKSETT RD UNIT 20
MANCHESTER NH
03104-2654
US

V. Phone/Fax

Practice location:
  • Phone: 603-641-4800
  • Fax: 603-622-3199
Mailing address:
  • Phone: 603-641-4800
  • Fax: 603-622-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number881
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3046
License Number StateNH

VIII. Authorized Official

Name: DR. ERIC M O'CONNELL
Title or Position: OWNER/MANAGER
Credential: DC
Phone: 603-641-4800