Organization
DR. MICHAEL R. CONDARAS DCCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R CONDARAS DCCC (CHIROPRACTOR)
(304) 342-3323
Entity
Organization
Contact information
Practice address
1202 VIRGINIA ST E, CHARLESTON, WV 25301-2909
(304) 342-3323
(304) 342-3357
Mailing address
1202 VIRGINIA ST E, CHARLESTON, WV 25301-2909
(304) 342-3323
(304) 342-3357
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
161
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0131291000
—
WV
01
—
CO 0383813
MEDICARE ID- TYPE UNSPECIFIED
WV
Enumeration date
02/17/2012
Last updated
02/17/2012
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