Provider Demographics
NPI:1811064140
Name:MCCONKEY, TRACY KURTISS (DC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:KURTISS
Last Name:MCCONKEY
Suffix:
Gender:M
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 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
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN732728500Medicaid
MN732728500Medicaid
MNU06229Medicare UPIN