Provider Demographics
NPI:1831339936
Name:MCCONKEY CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:MCCONKEY CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:KURTISS
Authorized Official - Last Name:MCCONKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-286-2500
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-0206
Mailing Address - Country:US
Mailing Address - Phone:320-286-2500
Mailing Address - Fax:320-286-2501
Practice Address - Street 1:15703 US HIGHWAY 12 SW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4624
Practice Address - Country:US
Practice Address - Phone:320-286-2500
Practice Address - Fax:320-286-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN732728500Medicaid
MN732728500Medicaid
MN350002558Medicare PIN