Provider Demographics
NPI:1487737490
Name:CONN, BART ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:BART
Middle Name:ANTHONY
Last Name:CONN
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 1:5820 OBERLIN DR STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3742
Mailing Address - Country:US
Mailing Address - Phone:858-678-8900
Mailing Address - Fax:858-678-8990
Practice Address - Street 1:5820 OBERLIN DR STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3742
Practice Address - Country:US
Practice Address - Phone:858-678-8900
Practice Address - Fax:858-678-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor