Healthcare Provider Details

I. General information

NPI: 1710199898
Provider Name (Legal Business Name): ALLEN A CONRAD II D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 WELSH RD WELSH COMMONS, SUITE B-2
NORTH WALES PA
19454-1913
US

IV. Provider business mailing address

1364 WELSH RD WELSH COMMONS, SUITE B-2
NORTH WALES PA
19454-1913
US

V. Phone/Fax

Practice location:
  • Phone: 215-628-2529
  • Fax: 215-583-3486
Mailing address:
  • Phone: 215-628-2529
  • Fax: 215-583-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC-008001-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberADJ-008001-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: