Provider Demographics
NPI:1801251491
Name:KONODONT
Entity type:Organization
Organization Name:KONODONT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMEBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-867-1444
Mailing Address - Street 1:14640 N TATUM BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4824
Mailing Address - Country:US
Mailing Address - Phone:602-867-1444
Mailing Address - Fax:602-867-7800
Practice Address - Street 1:14640 N TATUM BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4824
Practice Address - Country:US
Practice Address - Phone:602-867-1444
Practice Address - Fax:602-867-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty