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General NPI Number Information
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NPI Number | 1053376277
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Entity Type | Individual
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Provider Name | CONNON LEE PIENCIKOWSKI D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 1700 SAND ACRES DR STE 2A
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City | DE PERE
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State | WI
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Zip | 54115-7562
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Country | US
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Telephone | 920-591-0141
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Fax | 888-267-0230
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Provider Business Mailing Address
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Address Line | 1700 SAND ACRES DR STE 2A
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City | DE PERE
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State | WI
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Zip | 54115-7562
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Country | US
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Telephone | 920-591-0141
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Fax | 888-267-0230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 742-039
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4214-012
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License Number State | WI
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