Provider Demographics
NPI:1861665648
Name:KONOPKA CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:KONOPKA CHIROPRACTIC, PLLC
Other - Org Name:CENTRAL TEXAS CHIROPRACTIC AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KONOPKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-249-8800
Mailing Address - Street 1:200 BUTTERCUP CREEK BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3708
Mailing Address - Country:US
Mailing Address - Phone:512-249-8800
Mailing Address - Fax:512-249-0337
Practice Address - Street 1:200 BUTTERCUP CREEK BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3708
Practice Address - Country:US
Practice Address - Phone:512-249-8800
Practice Address - Fax:512-249-0337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL TEXAS CHIROPRACTIC AND REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU63888Medicare UPIN
TX605582Medicare PIN