Provider Demographics
NPI:1780715995
Name:CONN, JEFFREY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:CONN
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 1:20742 HALL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1537
Mailing Address - Country:US
Mailing Address - Phone:586-468-4461
Mailing Address - Fax:586-468-3636
Practice Address - Street 1:20742 HALL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1537
Practice Address - Country:US
Practice Address - Phone:586-468-4461
Practice Address - Fax:586-468-3636
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-E0-1938-0OtherBCBS OF MICHIGAN
MIU30476Medicare UPIN
MIU30476Medicare ID - Type UnspecifiedMEDICARE