1285820589 NPI number — KEVIN M. O'BRIEN DC PC

Table of content: (NPI 1285820589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285820589 NPI number — KEVIN M. O'BRIEN DC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEVIN M. O'BRIEN DC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285820589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 PLEASANT VALLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METHUEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01844-7204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-975-8510
Provider Business Mailing Address Fax Number:
978-975-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 PLEASANT VALLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METHUEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01844-7204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-975-8510
Provider Business Practice Location Address Fax Number:
978-975-5190
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OBRIEN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-975-8510

Provider Taxonomy Codes

  • Taxonomy code: 111NN0400X , with the licence number:  DC1626 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 351232 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y4004 . This is a "BC/BS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y36129 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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