Provider Demographics
NPI:1609122142
Name:DR. KEVIN P CONNER, PA
Entity Type:Organization
Organization Name:DR. KEVIN P CONNER, PA
Other - Org Name:CONGRESS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-847-3852
Mailing Address - Street 1:7534 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-1105
Mailing Address - Country:US
Mailing Address - Phone:727-847-3852
Mailing Address - Fax:727-849-9900
Practice Address - Street 1:7534 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-1105
Practice Address - Country:US
Practice Address - Phone:727-847-3852
Practice Address - Fax:727-849-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0008524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381720200Medicaid
FL1093775314OtherNPI
FLU0955Medicare UPIN