Provider Demographics
NPI:1972371920
Name:CONQUER HEALTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CONQUER HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:904-870-8701
Mailing Address - Street 1:530 STATE ROAD 13 S
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3865
Mailing Address - Country:US
Mailing Address - Phone:904-870-8701
Mailing Address - Fax:
Practice Address - Street 1:530 STATE ROAD 13 S
Practice Address - Street 2:UNIT 2
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3865
Practice Address - Country:US
Practice Address - Phone:904-870-8701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty