Provider Demographics
NPI:1306078555
Name:KONECNY CHIROPRACTIC CENTERS LLC
Entity type:Organization
Organization Name:KONECNY CHIROPRACTIC CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KONECNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-334-4448
Mailing Address - Street 1:2140 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1915
Mailing Address - Country:US
Mailing Address - Phone:203-334-4448
Mailing Address - Fax:203-333-1828
Practice Address - Street 1:2140 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1915
Practice Address - Country:US
Practice Address - Phone:203-334-4448
Practice Address - Fax:203-333-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000559Medicare PIN