Provider Demographics
NPI:1376751990
Name:CONLEY, JUDITH LYNN (DC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:CONLEY
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 1:512 EAST UNAKA AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4033
Mailing Address - Country:US
Mailing Address - Phone:423-929-9355
Mailing Address - Fax:423-929-8525
Practice Address - Street 1:512 EAST UNAKA AVENUE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4033
Practice Address - Country:US
Practice Address - Phone:423-929-9355
Practice Address - Fax:423-929-8525
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3675009Medicare ID - Type Unspecified
T81706Medicare UPIN