Provider Demographics
NPI:1083805394
Name:KONDUS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:KONDUS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KONDUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-584-4911
Mailing Address - Street 1:4045 SKIPPACK PIKE
Mailing Address - Street 2:
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474
Mailing Address - Country:US
Mailing Address - Phone:610-584-4911
Mailing Address - Fax:610-584-4877
Practice Address - Street 1:4045 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474
Practice Address - Country:US
Practice Address - Phone:610-584-4911
Practice Address - Fax:610-584-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006764L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA952760Medicare PIN