Provider Demographics
NPI:1770762981
Name:CONNOR, KENNETH JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOSEPH
Last Name:CONNOR
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 1:1670 SANTA ANA AVE STE G
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3840
Mailing Address - Country:US
Mailing Address - Phone:949-642-0888
Mailing Address - Fax:949-606-7227
Practice Address - Street 1:1670 SANTA ANA AVE STE G
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3840
Practice Address - Country:US
Practice Address - Phone:949-642-0888
Practice Address - Fax:949-606-7227
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor