Provider Demographics
NPI:1396820585
Name:CONNER, DAVID J (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:CONNER
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 1:429 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4530
Mailing Address - Country:US
Mailing Address - Phone:707-447-8100
Mailing Address - Fax:707-447-9900
Practice Address - Street 1:429 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4530
Practice Address - Country:US
Practice Address - Phone:707-447-8100
Practice Address - Fax:707-447-9900
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258460Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER