Provider Demographics
NPI:1003948373
Name:CONNOR, KEVIN D (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:CONNOR
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84909
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6209
Mailing Address - Country:US
Mailing Address - Phone:206-834-4100
Mailing Address - Fax:206-834-4131
Practice Address - Street 1:3670 STONE WAY N STE N271
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8004
Practice Address - Country:US
Practice Address - Phone:206-834-4100
Practice Address - Fax:206-834-4131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002439171100000X
WANT00001033175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036851Medicaid