Provider Demographics
NPI:1467668582
Name:CONDON, KRAIG JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRAIG
Middle Name:JOHN
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 1:9632 XIMINES LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3771
Mailing Address - Country:US
Mailing Address - Phone:763-424-5802
Mailing Address - Fax:
Practice Address - Street 1:6264 BOONE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-2729
Practice Address - Country:US
Practice Address - Phone:763-536-9700
Practice Address - Fax:763-536-3904
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU93952Medicare UPIN