Provider Demographics
NPI:1235439688
Name:H FREDERICK CONLEE DC
Entity Type:Organization
Organization Name:H FREDERICK CONLEE DC
Other - Org Name:YALE CHIROPRACTIC LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-387-3700
Mailing Address - Street 1:211 BROCKWAY RD
Mailing Address - Street 2:P.O. BOX 38
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097-3403
Mailing Address - Country:US
Mailing Address - Phone:810-387-3700
Mailing Address - Fax:810-387-3700
Practice Address - Street 1:211 BROCKWAY RD
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097-3403
Practice Address - Country:US
Practice Address - Phone:810-387-3700
Practice Address - Fax:810-387-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHC004017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0G45039OtherBLUE CROSS BLUE SHIELD
1154425312OtherNPI TYPE 1
0G45039Medicare PIN