Provider Demographics
NPI:1821021965
Name:CONANT, DONALD R II (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:CONANT
Suffix:II
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 1:1229 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2407
Mailing Address - Country:US
Mailing Address - Phone:217-544-4000
Mailing Address - Fax:217-544-4039
Practice Address - Street 1:1229 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2407
Practice Address - Country:US
Practice Address - Phone:217-544-4000
Practice Address - Fax:217-544-4039
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL073118OtherHEALTHLINK
IL8482040OtherBC/BS
IL8482040OtherBC/BS
IL395820Medicare ID - Type UnspecifiedGROUP #