Provider Demographics
NPI:1477573053
Name:MCCONNELL, KATHLEEN G (DC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:G
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 1:334 CASTLEGATE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-4418
Mailing Address - Country:US
Mailing Address - Phone:412-371-7152
Mailing Address - Fax:
Practice Address - Street 1:2728 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2420
Practice Address - Country:US
Practice Address - Phone:412-521-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003391-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29273Medicare UPIN
PA122607Medicare ID - Type Unspecified