Provider Demographics
NPI:1538257548
Name:CONNER, FELICIA MARIE (DC,DICCP)
Entity type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:MARIE
Last Name:CONNER
Suffix:
Gender:F
Credentials:DC,DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 PENN AVE S STE 245
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1504
Mailing Address - Country:US
Mailing Address - Phone:612-590-5881
Mailing Address - Fax:612-888-0111
Practice Address - Street 1:8120 PENN AVE S STE 245
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1504
Practice Address - Country:US
Practice Address - Phone:612-590-5881
Practice Address - Fax:612-888-0111
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4078111N00000X
MN4414111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38956900Medicaid
WIV03683Medicare UPIN
WI000235691Medicare ID - Type Unspecified
WI38956900Medicaid