Provider Demographics
NPI:1902283328
Name:KONOPKA, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:KONOPKA
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 1:88 RYDERS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1666
Mailing Address - Country:US
Mailing Address - Phone:203-375-1101
Mailing Address - Fax:203-375-1212
Practice Address - Street 1:88 RYDERS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1666
Practice Address - Country:US
Practice Address - Phone:203-375-1101
Practice Address - Fax:203-375-1212
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor