Provider Demographics
NPI:1992248959
Name:GOULD, CONRAD K (DC)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:K
Last Name:GOULD
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 1:7157 161ST ST
Mailing Address - Street 2:APT 6A
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4498
Mailing Address - Country:US
Mailing Address - Phone:914-772-3835
Mailing Address - Fax:
Practice Address - Street 1:125 CRESCENT PL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1603
Practice Address - Country:US
Practice Address - Phone:914-772-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor