Provider Demographics
NPI:1295838597
Name:MCCONNELL, RITA E (DC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:E
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W 8TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4125
Mailing Address - Country:US
Mailing Address - Phone:307-686-5709
Mailing Address - Fax:307-686-3691
Practice Address - Street 1:709 W 8TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4125
Practice Address - Country:US
Practice Address - Phone:307-686-5709
Practice Address - Fax:307-686-3691
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW20646Medicare ID - Type Unspecified