Provider Demographics
NPI:1124103593
Name:PAULEY CONLEY, BROOKE LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:LYNNE
Last Name:PAULEY 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 1:3405 RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4915
Mailing Address - Country:US
Mailing Address - Phone:740-456-6388
Mailing Address - Fax:740-456-6439
Practice Address - Street 1:3405 RHODES AVE
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-4915
Practice Address - Country:US
Practice Address - Phone:740-456-6388
Practice Address - Fax:740-456-6439
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0970427Medicaid
OHJO0760061Medicare ID - Type Unspecified
OH0970427Medicaid