Provider Demographics
NPI:1821047762
Name:CONRAD, CYNTHIA LEE (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
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 1:822 E UNION HILLS DR
Mailing Address - Street 2:D-22
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-8403
Mailing Address - Country:US
Mailing Address - Phone:623-582-8951
Mailing Address - Fax:623-581-8974
Practice Address - Street 1:822 E UNION HILLS DR
Practice Address - Street 2:D-22
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-8403
Practice Address - Country:US
Practice Address - Phone:623-582-8951
Practice Address - Fax:623-581-8974
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0945490OtherAZBCBS
AZ0945490OtherAZBCBS