Provider Demographics
NPI:1194732016
Name:OHARA, TOM (DC)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:OHARA
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 1:3035 S ELLSWORTH RD
Mailing Address - Street 2:109
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2160
Mailing Address - Country:US
Mailing Address - Phone:480-832-3318
Mailing Address - Fax:480-621-7208
Practice Address - Street 1:3035 S ELLSWORTH RD STE 109
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2136
Practice Address - Country:US
Practice Address - Phone:480-832-3318
Practice Address - Fax:480-621-7208
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC 4914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0236730OtherBCBS
AZU25671Medicare UPIN
AZZ113709Medicare PIN