Provider Demographics
NPI:1811962285
Name:MCCONNAUGHY, JOHN EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:MCCONNAUGHY
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 1:1027 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1540
Mailing Address - Country:US
Mailing Address - Phone:618-985-4344
Mailing Address - Fax:618-985-6469
Practice Address - Street 1:1027 S. DIVISION ST
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-0394
Practice Address - Country:US
Practice Address - Phone:618-985-4344
Practice Address - Fax:618-985-6469
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004817111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038004817Medicaid
ILT38135Medicare UPIN
F400189105Medicare PIN
IL038004817Medicaid