Provider Demographics
NPI:1871560789
Name:CONNER, BRENT ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALLEN
Last Name:CONNER
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 1:1493 E IRON AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3233
Mailing Address - Country:US
Mailing Address - Phone:785-309-0696
Mailing Address - Fax:785-309-0697
Practice Address - Street 1:1493 E IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3233
Practice Address - Country:US
Practice Address - Phone:785-309-0696
Practice Address - Fax:785-309-0697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062009Medicare ID - Type UnspecifiedMEDICARE PROVIDER
KSU96176Medicare UPIN