Provider Demographics
NPI:1982804191
Name:CONDE CENTER FOR CHIROPRACTIC NEUROLOGY INC
Entity type:Organization
Organization Name:CONDE CENTER FOR CHIROPRACTIC NEUROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-330-6096
Mailing Address - Street 1:401 W ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 014
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444
Mailing Address - Country:US
Mailing Address - Phone:561-330-6096
Mailing Address - Fax:
Practice Address - Street 1:401 W ATLANTIC AVENUE
Practice Address - Street 2:SUITE 014
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444
Practice Address - Country:US
Practice Address - Phone:561-330-6096
Practice Address - Fax:561-330-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8999111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9678OtherPTAN