Provider Demographics
NPI:1063746857
Name:CONRAD CHIROPRACTIC & WELLNESS P.C.
Entity type:Organization
Organization Name:CONRAD CHIROPRACTIC & WELLNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-596-8700
Mailing Address - Street 1:5962 STETSON HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3579
Mailing Address - Country:US
Mailing Address - Phone:719-596-8700
Mailing Address - Fax:719-596-8704
Practice Address - Street 1:5962 STETSON HILLS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3579
Practice Address - Country:US
Practice Address - Phone:719-596-8700
Practice Address - Fax:719-596-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-5831111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty