Provider Demographics
NPI:1790025450
Name:KONDRAD, KRISTOPHER SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:SCOTT
Last Name:KONDRAD
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 1:3220 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8302
Mailing Address - Country:US
Mailing Address - Phone:941-923-4357
Mailing Address - Fax:941-923-9943
Practice Address - Street 1:3220 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8302
Practice Address - Country:US
Practice Address - Phone:941-923-4357
Practice Address - Fax:941-923-9943
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000855111N00000X
FLCH12733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor