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	DC27322	CA
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ64181Z	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1518012202
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	:	719-434-1374

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	:	719-434-1374

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DR. JOHN PAUL CONDON
Credential	:	DC
Telephone Number	:	760-815-1833

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	02/16/2021

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