Provider Demographics
NPI:1285144311
Name:MCCONDUIT, JONATHAN (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:MCCONDUIT
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 1:791 N HIGHWAY 77 STE 501C206
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1977
Mailing Address - Country:US
Mailing Address - Phone:469-383-8387
Mailing Address - Fax:
Practice Address - Street 1:905 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2556
Practice Address - Country:US
Practice Address - Phone:972-937-0086
Practice Address - Fax:972-923-2351
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor