Provider Demographics
NPI:1578610556
Name:CONDON, JOHN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN PAUL
Middle Name:
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 1:447 ENCINITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3728
Mailing Address - Country:US
Mailing Address - Phone:760-783-0105
Mailing Address - Fax:
Practice Address - Street 1:447 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3728
Practice Address - Country:US
Practice Address - Phone:760-783-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0273220OtherBLUE CROSS
CAWDC27322AMedicare PIN