MEDICARE: DR. GREGORY ROBERT CONNER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3113	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3113	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1992886139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY ROBERT CONNER D.C.

Provider Business Mailing Address
First Line	:	3220 N ACADEMY BLVD
Second Line	:	SUITE 6
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5115
Country	:	US
Telephone Number	:	719-636-1615
Fax Number	:	719-591-1411

Provider Business Practice Location Address
First Line	:	3220 N ACADEMY BLVD
Second Line	:	SUITE 6
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5115
Country	:	US
Telephone Number	:	719-636-1615
Fax Number	:	719-591-1411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	04/18/2008

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