Provider Demographics
NPI:1700049301
Name:VONDRA FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:VONDRA FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:VONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-575-9922
Mailing Address - Street 1:186 E MAIN ST
Mailing Address - Street 2:5
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-7723
Mailing Address - Country:US
Mailing Address - Phone:775-575-9922
Mailing Address - Fax:
Practice Address - Street 1:186 E MAIN ST
Practice Address - Street 2:5
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-7723
Practice Address - Country:US
Practice Address - Phone:775-575-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-863261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114047990OtherINDIVIDUAL NPI