Provider Demographics
NPI:1780285874
Name:MCCONKEY, THADDEUS (DC)
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:
Last Name:MCCONKEY
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 1:2525 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1350
Mailing Address - Country:US
Mailing Address - Phone:248-535-8865
Mailing Address - Fax:
Practice Address - Street 1:3701 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3445
Practice Address - Country:US
Practice Address - Phone:817-962-0182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor