Provider Demographics
NPI:1255423091
Name:CONNOR, JOHN MOORE (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MOORE
Last Name:CONNOR
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 1:116 W 25TH ST
Mailing Address - Street 2:DR JOHN CONNOR
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-5518
Mailing Address - Country:US
Mailing Address - Phone:270-683-0563
Mailing Address - Fax:
Practice Address - Street 1:116 W 25TH ST
Practice Address - Street 2:DR JOHN CONNOR
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-5518
Practice Address - Country:US
Practice Address - Phone:270-683-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3713R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000347Medicaid
KY000000047391OtherANTHEM
KY000000047391OtherANTHEM
T54420Medicare UPIN