1235439688 NPI number — H FREDERICK CONLEE DC

Table of content: (NPI 1235439688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235439688 NPI number — H FREDERICK CONLEE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H FREDERICK CONLEE DC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
YALE CHIROPRACTIC LIFE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235439688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 BROCKWAY RD
Provider Second Line Business Mailing Address:
P.O. BOX 38
Provider Business Mailing Address City Name:
YALE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48097-3403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-387-3700
Provider Business Mailing Address Fax Number:
810-387-3700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 BROCKWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48097-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-387-3700
Provider Business Practice Location Address Fax Number:
810-387-3700
Provider Enumeration Date:
11/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
STEIN
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
CHIROPRACTIC ASSISTANT
Authorized Official Telephone Number:
810-387-3700

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  HC004017 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0G45039 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1154425312 . This is a "NPI TYPE 1" identifier . This identifiers is of the category "OTHER".




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