Provider Demographics
NPI:1710080395
Name:CONLEY, JODY J (DC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:J
Last Name:CONLEY
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 1:4500 S HAGADORN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-324-5433
Mailing Address - Fax:517-324-9594
Practice Address - Street 1:4500 S HAGADORN
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-324-5433
Practice Address - Fax:517-324-9594
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4571071Medicaid
MI950C350680OtherBCBS
MI1009992OtherMCLAREN
U65433Medicare UPIN
MI950C350680OtherBCBS