Healthcare Provider Details

I. General information

NPI: 1679767107
Provider Name (Legal Business Name): O'CONNOR SPORTS & SPINE CHIROPRACTIC P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
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: 718-370-0074
  • Fax: 718-948-1065
Mailing address:
  • Phone: 718-370-0074
  • Fax: 718-948-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX010462
License Number StateNY

VIII. Authorized Official

Name: DR. CHRISTOPHER THOMAS O'CONNOR
Title or Position: PRESIDENT
Credential: D.C.
Phone: 718-370-0074