Provider Demographics
NPI:1710009469
Name:CONRAD, ALIENORE (DC)
Entity Type:Individual
Prefix:
First Name:ALIENORE
Middle Name:
Last Name:CONRAD
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 1:21700 GOLDEN TRIANGLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2616
Mailing Address - Country:US
Mailing Address - Phone:661-253-1200
Mailing Address - Fax:661-253-1276
Practice Address - Street 1:21700 GOLDEN TRIANGLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2616
Practice Address - Country:US
Practice Address - Phone:661-253-1200
Practice Address - Fax:661-253-1276
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU69372Medicare UPIN