Provider Demographics
NPI:1790836625
Name:KONIKOWSKI, DAVID PETER (LAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PETER
Last Name:KONIKOWSKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:9301 E SHEA BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6733
Mailing Address - Country:US
Mailing Address - Phone:480-423-3525
Mailing Address - Fax:480-423-3540
Practice Address - Street 1:9301 E SHEA BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6733
Practice Address - Country:US
Practice Address - Phone:480-423-3525
Practice Address - Fax:480-423-3540
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist