Provider Demographics
NPI:1295082238
Name:KONOPACKI, LAURA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:KONOPACKI
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 1:2984 TRIVERTON PIKE DR
Mailing Address - Street 2:STE. 102
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5841
Mailing Address - Country:US
Mailing Address - Phone:608-556-1705
Mailing Address - Fax:
Practice Address - Street 1:2984 TRIVERTON PIKE DR
Practice Address - Street 2:STE. 102
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5841
Practice Address - Country:US
Practice Address - Phone:608-556-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3915-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI3123001Medicare PIN