Provider Demographics
NPI:1457411159
Name:MCCONNELL, DANIEL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMAS
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1605 W CANDLETREE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1562
Mailing Address - Country:US
Mailing Address - Phone:309-692-2230
Mailing Address - Fax:309-692-6136
Practice Address - Street 1:1605 W CANDLETREE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1562
Practice Address - Country:US
Practice Address - Phone:309-692-2230
Practice Address - Fax:309-692-6136
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL613020Medicare PIN