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General NPI Number Information
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NPI Number | 1710200100
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Entity Type | Organization
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Legal Business Name | D.JORDAN CONRAD DC PC
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Dates
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Enumeration Date | 03/12/2010
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 313 ELMWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14222-2203
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Country | US
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Telephone | 716-882-8800
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Fax | 716-881-1382
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Provider Business Mailing Address
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Address Line | 313 ELMWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14222-2203
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Country | US
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Telephone | 716-882-8800
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Fax | 716-881-1382
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Authorized Official
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Title or Position | OWNER
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Name | D. JORDAN CONRAD
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Credential | DC
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Telephone | 716-882-8800
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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 | X0114531
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License Number State | NY
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