Provider Demographics
NPI:1831260660
Name:CONDE, JUAN CARLOS (DC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:CONDE
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 1:16279 SIERRA PALMS DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6406
Mailing Address - Country:US
Mailing Address - Phone:561-498-0147
Mailing Address - Fax:
Practice Address - Street 1:401 W ATLANTIC AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3689
Practice Address - Country:US
Practice Address - Phone:561-330-6096
Practice Address - Fax:561-330-6097
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8999111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64163OtherBCBS
FLK9678Medicare ID - Type Unspecified