Provider Demographics
NPI:1528348133
Name:CONNOR, LAURA JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEAN
Last Name:CONNOR
Suffix:
Gender:F
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-0039
Mailing Address - Country:US
Mailing Address - Phone:715-478-5202
Mailing Address - Fax:715-478-5205
Practice Address - Street 1:505 W GLEN ST
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1356
Practice Address - Country:US
Practice Address - Phone:715-478-5202
Practice Address - Fax:715-478-5205
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4632-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor