Healthcare Provider Details

I. General information

NPI: 1104635697
Provider Name (Legal Business Name): CONNOR THELEMANN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 84TH ST
BLOOMINGTON MN
55431-1602
US

IV. Provider business mailing address

15696 FINEWOOD CT
APPLE VALLEY MN
55124-5810
US

V. Phone/Fax

Practice location:
  • Phone: 952-432-4444
  • Fax:
Mailing address:
  • Phone: 952-297-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7284
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: