Provider Demographics
NPI:1598063802
Name:CONNER, KRISTINA (ND, MSOM)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:ND, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17W703 BUTTERFIELD RD STE F
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4280
Mailing Address - Country:US
Mailing Address - Phone:630-359-5522
Mailing Address - Fax:
Practice Address - Street 1:17W703 BUTTERFIELD RD STE F
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4280
Practice Address - Country:US
Practice Address - Phone:630-359-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000285175F00000X
IL198001195171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist