Provider Demographics
NPI:1457470130
Name:CONDON, ROBERT M (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:CONDON
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 1:288 GROVELAND ST
Mailing Address - Street 2:SUITE C2
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6674
Mailing Address - Country:US
Mailing Address - Phone:978-372-1400
Mailing Address - Fax:
Practice Address - Street 1:288 GROVELAND ST
Practice Address - Street 2:SUITE C2
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6674
Practice Address - Country:US
Practice Address - Phone:978-372-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4401122OtherUNITED HEALTHCARE
NH05Y011348MA01OtherANTHEM BLUECROSS
MA1696734Medicaid
MA517930OtherCIGNA
MA461427OtherTUFTS HEALTH PLAN
MA2316269OtherAETNA
MAAA58738OtherHARVARD PILGRIM
MAY36733OtherBLUECROSS BLUESHIELD
MA461427OtherTUFTS HEALTH PLAN
MAY36733OtherBLUECROSS BLUESHIELD