=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346429719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONDON CHIROPRACTIC CLINIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2007
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 FAIRVIEW AVE
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18042-3915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-250-8898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 FAIRVIEW AVE
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18042-3915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-250-8898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. RACHELLE MCCORMICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-541-5557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC007212L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------