Provider Demographics
NPI:1821363193
Name:CHIPP-NATHANIEL, CONNIE YVONNE (DC)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:YVONNE
Last Name:CHIPP-NATHANIEL
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:PO BOX 4444
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-0444
Mailing Address - Country:US
Mailing Address - Phone:913-579-1154
Mailing Address - Fax:913-273-0081
Practice Address - Street 1:7423 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-1975
Practice Address - Country:US
Practice Address - Phone:913-579-1154
Practice Address - Fax:913-273-0081
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012002918111N00000X
KS01-05469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor