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General NPI Number Information
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NPI Number | 1609992122
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Entity Type | Organization
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Legal Business Name | DR CRAIG CONNER CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 2705 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-7864
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Country | US
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Telephone | 636-978-6995
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Fax |
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Provider Business Mailing Address
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Address Line | 54 MALLARD POINTE DR
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City | O FALLON
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State | MO
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Zip | 63368-8312
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Country | US
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Telephone | 636-978-6995
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRAIG CONNER
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Credential | DC
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Telephone | 636-978-6995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2006029728
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License Number State | MO
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