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General NPI Number Information
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NPI Number | 1437368032
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Entity Type | Organization
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Legal Business Name | JOHN W. CONRAD D.C. CORP.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 404 W LAUREL AVE
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City | GLENDORA
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State | CA
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Zip | 91741-2030
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Country | US
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Telephone | 626-506-5426
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Fax | 626-914-2747
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Provider Business Mailing Address
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Address Line | 404 W LAUREL AVE
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City | GLENDORA
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State | CA
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Zip | 91741-2030
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Country | US
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Telephone | 626-506-5426
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Fax | 626-914-2747
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN W. CONRAD
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Credential | D.C.
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Telephone | 626-506-5426
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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 | DC22633
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License Number State | CA
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