Provider Demographics
NPI:1093775314
Name:CONNER, KEVIN PATRICK (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:CONNER
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7534 CONGRESS STREET
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653
Mailing Address - Country:US
Mailing Address - Phone:727-847-3852
Mailing Address - Fax:727-849-9900
Practice Address - Street 1:7534 CONGRESS STREET
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653
Practice Address - Country:US
Practice Address - Phone:727-847-3852
Practice Address - Fax:727-849-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0008524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL231111OtherHEALTHNET STAYWELL WELLCO
FL381720200Medicaid
FL7498600OtherAETNA
FLU0955Medicare UPIN
FL381720200Medicaid