Provider Demographics
NPI:1700886876
Name:CONDON, HEATH (DC)
Entity Type:Individual
Prefix:MR
First Name:HEATH
Middle Name:
Last Name:CONDON
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 1:825 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-6513
Mailing Address - Country:US
Mailing Address - Phone:610-250-8898
Mailing Address - Fax:610-438-4482
Practice Address - Street 1:825 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-6513
Practice Address - Country:US
Practice Address - Phone:610-250-8898
Practice Address - Fax:610-438-4482
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007212L111N00000X
NJMC05198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1453737OtherHIGHMARK, KEYSTONE
PA02664200OtherCAPITAL BLUE CROSS
PA1033631OtherASHN
PA20024509OtherAMERIHEALTH
PA2139738000OtherKEYSTONE EAST
PA3098747OtherAETNA
PA077209SKFMedicare PIN
PA02664200OtherCAPITAL BLUE CROSS