Provider Demographics
NPI:1053649160
Name:KONZ, ANDREW JAMES (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:KONZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 KENTUCKY AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2122
Mailing Address - Country:US
Mailing Address - Phone:612-237-5609
Mailing Address - Fax:763-536-0471
Practice Address - Street 1:4345 NATHAN LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-4522
Practice Address - Country:US
Practice Address - Phone:763-536-1112
Practice Address - Fax:763-536-0471
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor