Provider Demographics
NPI:1295947893
Name:CONNER, DANIEL W (DC CCSP)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:CONNER
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5320 N 16TH ST
Mailing Address - Street 2:SUITE #107
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:602-234-2611
Mailing Address - Fax:602-234-2612
Practice Address - Street 1:5320 N 16TH ST
Practice Address - Street 2:SUITE #107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-234-2611
Practice Address - Fax:602-234-2612
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
623260OtherACN UNITED HEALTH INC
AZAZ0086040OtherBLUE CROSS BLUE SHIELD OF