Donald Jordan Conrad, D.C.
Individual provider Active NPI Chiropractor · Derby, NY
NPI 1770748246 · NPPES record last updated Nov 19, 2020
Key facts
- NPI
- 1770748246
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 011453 (NY)
- Practice address
- 7060 Erie Rd
Suite 300
Derby, NY 14047-9416 - Phone
- (716) 947-0139
- Fax
- (716) 947-0320
- NPI assigned
- Jul 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011453 | NY | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Chiropractic, P.C. | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 011453 | NY | Yes |
Addresses
Primary practice location
7060 Erie Rd
Suite 300
Derby, NY 14047-9416
Mailing address
6470 Main St
Ste 2
Williamsville, NY 14221-5851
Phone (716) 580-3577
Other providers in Derby, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.