Provider Demographics
NPI:1770748246
Name:CONRAD, DONALD JORDAN (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JORDAN
Last Name:CONRAD
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 1:6470 MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5851
Mailing Address - Country:US
Mailing Address - Phone:716-580-3577
Mailing Address - Fax:
Practice Address - Street 1:7060 ERIE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9416
Practice Address - Country:US
Practice Address - Phone:716-947-0139
Practice Address - Fax:716-947-0320
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor