Provider Demographics
NPI:1760838130
Name:CONLEY, STEPHAN (DC, LMT,)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:DC, LMT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-0261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1502 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6307
Practice Address - Country:US
Practice Address - Phone:479-285-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2021-06-16
Deactivation Date:2018-05-17
Deactivation Code:
Reactivation Date:2021-06-16
Provider Licenses
StateLicense IDTaxonomies
TX13111111N00000X
TXMT15303225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist