Provider Demographics
NPI:1518012202
Name:CONDON CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CONDON CHIROPRACTIC PLLC
Other - Org Name:CHIROPRACTIC LIFE CNETER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-815-1833
Mailing Address - Street 1:7146 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3185
Mailing Address - Country:US
Mailing Address - Phone:719-434-1246
Mailing Address - Fax:719-434-1374
Practice Address - Street 1:7146 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3185
Practice Address - Country:US
Practice Address - Phone:719-434-1246
Practice Address - Fax:719-434-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27322111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64181ZOtherBLUE CROSS
CAZZZ64181ZOtherBLUE CROSS