Healthcare Provider Details

I. General information

NPI: 1801251491
Provider Name (Legal Business Name): KONODONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14640 N TATUM BLVD SUITE 7
PHOENIX AZ
85032-4824
US

IV. Provider business mailing address

14640 N TATUM BLVD SUITE 7
PHOENIX AZ
85032-4824
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-1444
  • Fax: 602-867-7800
Mailing address:
  • Phone: 602-867-1444
  • Fax: 602-867-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ALAN LIPMAN
Title or Position: MEMEBER
Credential: D.C.
Phone: 602-867-1444