Provider Demographics
NPI:1558361022
Name:KONOPKA, JOSEPH A (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:KONOPKA
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:PO BOX 2427
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22195-2427
Mailing Address - Country:US
Mailing Address - Phone:703-878-3232
Mailing Address - Fax:703-878-3232
Practice Address - Street 1:4343 RIDGEWOOD CENTER DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5308
Practice Address - Country:US
Practice Address - Phone:703-878-3232
Practice Address - Fax:703-878-3232
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T97158Medicare UPIN