Provider Demographics
NPI:1487751533
Name:CONDON, CHRISTOPHER R (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:CONDON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10565 N 114TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4942
Mailing Address - Country:US
Mailing Address - Phone:480-809-4700
Mailing Address - Fax:480-809-4704
Practice Address - Street 1:10565 N 114TH ST STE 109
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4942
Practice Address - Country:US
Practice Address - Phone:480-809-4700
Practice Address - Fax:480-809-4704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45353Medicare ID - Type Unspecified