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General NPI Number Information
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NPI Number | 1831339936
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Entity Type | Organization
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Legal Business Name | MCCONKEY CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 15703 US HIGHWAY 12 SW
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City | COKATO
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State | MN
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Zip | 55321-4624
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Country | US
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Telephone | 320-286-2500
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Fax | 320-286-2501
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Provider Business Mailing Address
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Address Line | PO BOX 206
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City | COKATO
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State | MN
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Zip | 55321-0206
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Country | US
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Telephone | 320-286-2500
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Fax | 320-286-2501
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | TRACY KURTISS MCCONKEY
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Credential | D.C.
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Telephone | 320-286-2500
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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 |
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License Number State |
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