Healthcare Provider Details

I. General information

NPI: 1659449247
Provider Name (Legal Business Name): WILLIAM EDWARD OBRIEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CRYSTAL STREET
EAST STROUDSBURG PA
18301
US

IV. Provider business mailing address

75 CRYSTAL STREET
EAST STROUDSBURG PA
18301
US

V. Phone/Fax

Practice location:
  • Phone: 570-424-6871
  • Fax: 570-424-6875
Mailing address:
  • Phone: 570-424-6871
  • Fax: 570-424-6875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC002060L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: