MEDICARE: LARA CONDON DC

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	0008172	CO

General Provider Information

NPI Number	:	1437742921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA CONDON DC

Provider Business Mailing Address
First Line	:	13904 SIERRA STAR CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2976
Country	:	US
Telephone Number	:	760-644-6757
Fax Number	:

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	:	719-434-1374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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