Provider Demographics
NPI:1699828210
Name:CONNERS, KEVIN SEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SEAN
Last Name:CONNERS
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 1:11955 102ND ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9108
Mailing Address - Country:US
Mailing Address - Phone:651-439-9518
Mailing Address - Fax:
Practice Address - Street 1:7582 CURRELL BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2262
Practice Address - Country:US
Practice Address - Phone:651-739-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350056695OtherRAILROAD MEDICARE NUMBER
MN399527500Medicaid
MN85784OtherHEALTH-PARTNERS NUMBERSE
MN399527500Medicaid
MN85784OtherHEALTH-PARTNERS NUMBERSE