Provider Demographics
NPI:1801984877
Name:OBRIEN, JOHN J (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 PAWLING AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5834
Mailing Address - Country:US
Mailing Address - Phone:518-286-3060
Mailing Address - Fax:518-286-3044
Practice Address - Street 1:492 PAWLING AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-5834
Practice Address - Country:US
Practice Address - Phone:518-286-3060
Practice Address - Fax:518-286-3044
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0066141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY98L1915OtherMVP
X54101OtherBLUE CROSS BLUE SHIELD
NYC066144OtherWORKERS COMPENSATION
NY10021222OtherCDPHP
NY607980OtherMPN
NY607980OtherMPN
53944BMedicare PIN