MEDICARE: DR. KRAIG JOHN 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	3564	MN

General Provider Information

NPI Number	:	1467668582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRAIG JOHN CONDON DC

Provider Business Mailing Address
First Line	:	9632 XIMINES LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-3771
Country	:	US
Telephone Number	:	763-424-5802
Fax Number	:

Provider Business Practice Location Address
First Line	:	6264 BOONE AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-2729
Country	:	US
Telephone Number	:	763-536-9700
Fax Number	:	763-536-3904

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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