Provider Demographics
NPI:1831287051
Name:JOYNER, KONNIE LAUREL (DC)
Entity Type:Individual
Prefix:DR
First Name:KONNIE
Middle Name:LAUREL
Last Name:JOYNER
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 1:1419B N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3467
Mailing Address - Country:US
Mailing Address - Phone:731-422-4037
Mailing Address - Fax:731-422-6449
Practice Address - Street 1:1419B N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3467
Practice Address - Country:US
Practice Address - Phone:731-422-4037
Practice Address - Fax:731-422-6449
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3678208Medicaid
TN3678208Medicare ID - Type Unspecified
TN3678208Medicaid