Provider Demographics
NPI:1750426268
Name:BICKHARD, CONN DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:CONN
Middle Name:DANIEL
Last Name:BICKHARD
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 1:4701 SOUTHWEST PKWY STE 18
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-3269
Mailing Address - Country:US
Mailing Address - Phone:940-696-2262
Mailing Address - Fax:940-691-0451
Practice Address - Street 1:4701 SOUTHWEST PKWY STE 18
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-3269
Practice Address - Country:US
Practice Address - Phone:940-696-2262
Practice Address - Fax:940-691-0451
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8221730OtherBLUE LINK #
TX665600OtherACN GROUP, INC. #
TX3083OtherCHIRO. LICENSE #
TX601525OtherBCBS
TX8221730OtherBLUE LINK #
TX601525Medicare ID - Type UnspecifiedMCR PROVIDER #