Provider Demographics
NPI:1275725988
Name:CARPENTER-FARLEY, CONNIE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:LYNN
Last Name:CARPENTER-FARLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 HENRY ST.
Mailing Address - Street 2:SUITE # 214
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6323
Mailing Address - Country:US
Mailing Address - Phone:618-465-9708
Mailing Address - Fax:
Practice Address - Street 1:209 HENRY ST.
Practice Address - Street 2:SUITE # 214
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6323
Practice Address - Country:US
Practice Address - Phone:618-465-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005027601111N00000X
IL038-010437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor