Provider Demographics
NPI:1548362072
Name:O'CONNOR, TIMOTHY J (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:O'CONNOR
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 1:2021 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4945
Mailing Address - Country:US
Mailing Address - Phone:920-735-2828
Mailing Address - Fax:920-735-2981
Practice Address - Street 1:2021 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4945
Practice Address - Country:US
Practice Address - Phone:920-735-2828
Practice Address - Fax:920-735-2981
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
391936002008OtherBLUE CROSS BLUE SHIELD
WI38841000Medicaid
WI38841000Medicaid