Provider Demographics
NPI:1144341702
Name:KAY B O'HARA PA EASTERN CHIROPRACTIC
Entity type:Organization
Organization Name:KAY B O'HARA PA EASTERN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:OHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-686-1117
Mailing Address - Street 1:616 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221
Mailing Address - Country:US
Mailing Address - Phone:410-686-1117
Mailing Address - Fax:410-686-1751
Practice Address - Street 1:616 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-4907
Practice Address - Country:US
Practice Address - Phone:410-686-1117
Practice Address - Fax:410-686-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK104OtherCAREFIRST
MDT139 0001OtherCAREFIRST
MDK104OtherCAREFIRST
MDU05314Medicare UPIN