Healthcare Provider Details

I. General information

NPI: 1124154430
Provider Name (Legal Business Name): CHRISTOPHER THOMAS O'CONNOR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 RICHMOND AVE
STATEN ISLAND NY
10314-7450
US

IV. Provider business mailing address

1274 RICHMOND AVE
STATEN ISLAND NY
10314-7450
US

V. Phone/Fax

Practice location:
  • Phone: 646-662-3742
  • Fax:
Mailing address:
  • Phone: 718-370-0074
  • Fax: 718-370-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX10462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: