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General NPI Number Information
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NPI Number | 1407596976
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Entity Type | Individual
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Provider Name | WILLIAM JOHN RUSSELL O'NEILL DC
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Gender | Male
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Dates
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Enumeration Date | 03/31/2022
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 1587 TAURUS COURT
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City | LOVELAND
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State | CO
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Zip | 80537
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Country | US
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Telephone | 970-430-5756
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Fax |
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Provider Business Mailing Address
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Address Line | 5228 ALBERTA FALLS ST
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City | TIMNATH
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State | CO
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Zip | 80547-5807
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Country | US
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Telephone | 970-372-8804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR.0002264
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License Number State | CO
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