MEDICARE: DR. SHANE REED CONRAD DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHR-5831	CO

General Provider Information

NPI Number	:	1184712036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE REED CONRAD DC

Provider Business Mailing Address
First Line	:	5962 STETSON HILLS BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-3579
Country	:	US
Telephone Number	:	719-596-8700
Fax Number	:	719-596-8704

Provider Business Practice Location Address
First Line	:	5962 STETSON HILLS BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-3579
Country	:	US
Telephone Number	:	719-596-8700
Fax Number	:	719-596-8704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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