Provider Demographics
NPI:1619170636
Name:DAVID M COONRAD DC PA
Entity type:Organization
Organization Name:DAVID M COONRAD DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:COONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC PA
Authorized Official - Phone:201-634-9006
Mailing Address - Street 1:625 FROM RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3500
Mailing Address - Country:US
Mailing Address - Phone:201-634-9006
Mailing Address - Fax:201-634-9690
Practice Address - Street 1:625 FROM RD
Practice Address - Street 2:SUITE 10
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3500
Practice Address - Country:US
Practice Address - Phone:201-634-9006
Practice Address - Fax:201-634-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ 38MCOO144100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096267Medicare ID - Type Unspecified