MEDICARE: OCONNOR CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15005	CA

General Provider Information

NPI Number	:	1861559338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCONNOR CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	12250 LA MIRADA BLVD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-1306
Country	:	US
Telephone Number	:	562-943-0141
Fax Number	:	562-947-7246

Provider Business Practice Location Address
First Line	:	12250 LA MIRADA BLVD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-1306
Country	:	US
Telephone Number	:	562-943-0141
Fax Number	:	562-947-7246

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	BARRY KEVIN OCONNOR
Credential	:	DC
Telephone Number	:	562-943-0141

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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