Provider Demographics
NPI:1114562535
Name:ACKERMAN, KONNER JAMES (DC, MS, ATC)
Entity Type:Individual
Prefix:DR
First Name:KONNER
Middle Name:JAMES
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:DC, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 SE PINE ST APT S101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-4608
Mailing Address - Country:US
Mailing Address - Phone:206-851-6873
Mailing Address - Fax:
Practice Address - Street 1:940 RIDGEVIEW DR STE 100A
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5443
Practice Address - Country:US
Practice Address - Phone:206-851-6873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor