Provider Demographics
NPI:1639143068
Name:MCCONNELL, ROBIN K (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:K
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 1:1106 COCOA AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1712
Mailing Address - Country:US
Mailing Address - Phone:717-520-1212
Mailing Address - Fax:717-520-1221
Practice Address - Street 1:1106 COCOA AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1712
Practice Address - Country:US
Practice Address - Phone:717-520-1212
Practice Address - Fax:717-520-1221
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 008970111N00000X
PAAJ008112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA358450OtherGROUP HIGHMARK PROVIDER
PAMC1638328OtherHIGHMARK
PA7748676OtherAETNA PPO
PA3794669OtherAETNA HMO
PA7748676OtherAETNA PPO
PA024547Medicare ID - Type UnspecifiedGROUP MEDICARE
PA358450OtherGROUP HIGHMARK PROVIDER
PAU94299Medicare UPIN