Provider Demographics
NPI:1205495066
Name:COONRAD, TROY (DC)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:COONRAD
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 1:6220 GEORGETOWN BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6417
Mailing Address - Country:US
Mailing Address - Phone:410-795-7766
Mailing Address - Fax:410-795-7000
Practice Address - Street 1:6220 GEORGETOWN BLVD STE E
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6417
Practice Address - Country:US
Practice Address - Phone:410-795-7766
Practice Address - Fax:410-795-7000
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor