Healthcare Provider Details

I. General information

NPI: 1306841184
Provider Name (Legal Business Name): THOMAS JOHN KONDNER D.C.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BROADWAY
HANOVER PA
17331-2513
US

IV. Provider business mailing address

120 BROADWAY
HANOVER PA
17331-2513
US

V. Phone/Fax

Practice location:
  • Phone: 717-630-9292
  • Fax: 717-630-0488
Mailing address:
  • Phone: 717-630-9292
  • Fax: 717-630-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-004797-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: