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General NPI Number Information
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NPI Number | 1285144311
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Entity Type | Individual
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Provider Name | JONATHAN MCCONDUIT DC
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Gender | Male
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 905 FERRIS AVE
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City | WAXAHACHIE
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State | TX
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Zip | 75165-2556
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Country | US
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Telephone | 972-937-0086
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Fax | 972-923-2351
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Provider Business Mailing Address
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Address Line | 791 N HIGHWAY 77 STE 501C206
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City | WAXAHACHIE
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State | TX
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Zip | 75165-1977
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Country | US
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Telephone | 469-383-8387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 13527
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License Number State | TX
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