Provider Demographics
NPI:1427263987
Name:MONTGOMERY COUNTY WELLNESS CENTER
Entity type:Organization
Organization Name:MONTGOMERY COUNTY WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS, DC, CSCS
Authorized Official - Phone:215-628-2529
Mailing Address - Street 1:1120 WELSH RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454
Mailing Address - Country:US
Mailing Address - Phone:215-628-2529
Mailing Address - Fax:215-583-3486
Practice Address - Street 1:1120 WELSH RD
Practice Address - Street 2:SUITE #110
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454
Practice Address - Country:US
Practice Address - Phone:215-628-2529
Practice Address - Fax:215-583-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-008001-L111N00000X
PAADJ-008001-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty