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General NPI Number Information
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NPI Number | 1881355303
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Entity Type | Organization
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Legal Business Name | CONRAD SPINE AND SPORT
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 8765 STOCKARD DR STE 901
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City | FRISCO
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State | TX
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Zip | 75034-8009
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Country | US
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Telephone | 469-552-5904
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 WHITESTONE LN APT 1431
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City | PLANO
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State | TX
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Zip | 75024-3039
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Country | US
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Telephone | 417-350-5722
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS D. CONRAD
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Credential | DC
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Telephone | 469-552-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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