NPIMap

Organization Active NPI

D.Jordan Conrad DC PC

  • Chiropractor
  • Buffalo, NY
National Provider Identifier
1710200100
Registry record updated Dec 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X0114531 Issued in NY
Legal business name
D.JORDAN CONRAD DC PC
Doing business as
Genesis Chiropractic
Practice address
313 Elmwood Ave
Buffalo, NY 14222-2203
Phone
(716) 882-8800
Fax
(716) 881-1382
NPI assigned
Mar 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
D. Jordan Conrad, DC
Title
Owner
Phone
(716) 882-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X X0114531 NY Primary

Addresses

Primary practice location

313 Elmwood Ave
Buffalo, NY 14222-2203

Mailing address

313 Elmwood Ave
Buffalo, NY 14222-2203
Phone (716) 882-8800

Other identifiers 1

IdentifierTypeStateIssuer
05084895MedicaidNY

Other names 1

  • Genesis Chiropractic Doing business as

National Provider Directory

National Provider Directory

Locations

313 Elmwood Ave
Buffalo, NY 14222
Phone (716) 780-2662

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575417600000",
    "number": "1710200100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 ELMWOOD AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142222203",
            "telephone_number": "716-882-8800",
            "fax_number": "716-881-1382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 ELMWOOD AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142222203",
            "telephone_number": "716-882-8800",
            "fax_number": "716-881-1382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D.JORDAN CONRAD DC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-12",
        "last_updated": "2019-12-04",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "D.",
        "authorized_official_middle_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-882-8800",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X0114531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05084895",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.