Provider Demographics
NPI:1053376277
Name:PIENCIKOWSKI, CONNON LEE (DC)
Entity type:Individual
Prefix:
First Name:CONNON
Middle Name:LEE
Last Name:PIENCIKOWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SAND ACRES DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7562
Mailing Address - Country:US
Mailing Address - Phone:920-591-0141
Mailing Address - Fax:888-267-0230
Practice Address - Street 1:1700 SAND ACRES DR STE 2A
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7562
Practice Address - Country:US
Practice Address - Phone:920-591-0141
Practice Address - Fax:888-267-0230
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI742-0392255A2300X
WI4214-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4214-012OtherLICENSE NUMBER