Provider Demographics
NPI:1801286653
Name:CONDOS, DAJANA (DC)
Entity type:Individual
Prefix:DR
First Name:DAJANA
Middle Name:
Last Name:CONDOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DAJANA
Other - Middle Name:MARGARET
Other - Last Name:VIDOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 S POKEGAMA AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4291
Mailing Address - Country:US
Mailing Address - Phone:218-999-7006
Mailing Address - Fax:
Practice Address - Street 1:1200 S POKEGAMA AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4291
Practice Address - Country:US
Practice Address - Phone:218-349-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor