MEDICARE: CONDON CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1215505318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONDON CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	7146 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3185
Country	:	US
Telephone Number	:	719-434-1246
Fax Number	:	719-434-1325

Provider Business Practice Location Address
First Line	:	7146 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3185
Country	:	US
Telephone Number	:	719-434-1246
Fax Number	:	719-434-1325

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN PAUL CONDON
Credential	:	DC
Telephone Number	:	719-434-1246

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/15/2021

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