Provider Demographics
NPI:1316586449
Name:O'KANE, SAMANTHA DAVENPORT
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DAVENPORT
Last Name:O'KANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:SHANTEL
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 E ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5809
Mailing Address - Country:US
Mailing Address - Phone:252-756-6111
Mailing Address - Fax:
Practice Address - Street 1:704 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5809
Practice Address - Country:US
Practice Address - Phone:252-756-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor