Provider Demographics
NPI:1588143374
Name:O'BRIEN, ERIC D (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:O'BRIEN
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 1:1851 44TH ST SW STE N
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-6440
Mailing Address - Country:US
Mailing Address - Phone:616-538-9880
Mailing Address - Fax:
Practice Address - Street 1:1851 44TH ST SW STE N
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-6440
Practice Address - Country:US
Practice Address - Phone:616-538-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor