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General NPI Number Information
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NPI Number | 1619170636
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Entity Type | Organization
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Legal Business Name | DAVID M COONRAD DC PA
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 625 FROM RD SUITE 10
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City | PARAMUS
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State | NJ
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Zip | 07652-3500
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Country | US
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Telephone | 201-634-9006
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Fax | 201-634-9690
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Provider Business Mailing Address
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Address Line | 625 FROM RD SUITE 10
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City | PARAMUS
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State | NJ
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Zip | 07652-3500
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Country | US
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Telephone | 201-634-9006
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Fax | 201-634-9690
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID M COONRAD
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Credential | DC PA
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Telephone | 201-634-9006
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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 | NJ 38MCOO144100
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License Number State | NJ
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