Provider Demographics
NPI:1093358186
Name:KONDRAD CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KONDRAD CHIROPRACTIC LLC
Other - Org Name:BRANDYWINE HEALTH CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KONDRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-562-3314
Mailing Address - Street 1:3220 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8302
Mailing Address - Country:US
Mailing Address - Phone:941-923-4357
Mailing Address - Fax:941-923-9943
Practice Address - Street 1:3220 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231
Practice Address - Country:US
Practice Address - Phone:941-923-4357
Practice Address - Fax:941-923-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty