Provider Demographics
NPI:1306915343
Name:KONICK, WENDY A (DC)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:A
Last Name:KONICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:A
Other - Last Name:LEVENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:16251 MINNEHAHA ST
Mailing Address - Street 2:SUITE
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6837
Mailing Address - Country:US
Mailing Address - Phone:818-831-3448
Mailing Address - Fax:818-831-3448
Practice Address - Street 1:9535 RESEDA BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:818-886-8018
Practice Address - Fax:818-831-3448
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26093Medicare ID - Type Unspecified
U83056Medicare UPIN