Provider Demographics
NPI:1871687616
Name:O'CONNOR FAMILY WELLNESS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:O'CONNOR FAMILY WELLNESS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-664-6000
Mailing Address - Street 1:30 HARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1822
Mailing Address - Country:US
Mailing Address - Phone:201-664-6000
Mailing Address - Fax:201-666-1380
Practice Address - Street 1:30 HARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1822
Practice Address - Country:US
Practice Address - Phone:201-664-6000
Practice Address - Fax:201-666-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00257900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0070233RTEMedicare ID - Type Unspecified