Provider Demographics
NPI:1689760399
Name:CONARD, SANDRA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:CONARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730
Mailing Address - Country:US
Mailing Address - Phone:605-673-5971
Mailing Address - Fax:605-673-5972
Practice Address - Street 1:246 N 5TH ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730
Practice Address - Country:US
Practice Address - Phone:605-673-5971
Practice Address - Fax:605-673-5972
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601470Medicaid
SD7601470Medicaid
SDS100508Medicare PIN