MEDICARE: JOHN W. CONRAD D.C. CORP.

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	DC22633	CA

General Provider Information

NPI Number	:	1437368032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN W. CONRAD D.C. CORP.

Provider Business Mailing Address
First Line	:	404 W LAUREL AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-2030
Country	:	US
Telephone Number	:	626-506-5426
Fax Number	:	626-914-2747

Provider Business Practice Location Address
First Line	:	404 W LAUREL AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-2030
Country	:	US
Telephone Number	:	626-506-5426
Fax Number	:	626-914-2747

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN W. CONRAD
Credential	:	D.C.
Telephone Number	:	626-506-5426

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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