Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | XOO9292 | NY |
Y | 111NS0005X | Chiropractic Sports Physician | 0104001121 | VA |
NPI | 1235229097 |
---|---|
Provider Name | Dr. Dennis P O'hara |
First Address | Chantilly, VA 20151 |
Second Address | Chantilly, VA 20151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 06/01/2016 |