Provider Demographics
NPI:1386876621
Name:CONLEY, LEVI JACKSON (DIPLAC)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:JACKSON
Last Name:CONLEY
Suffix:
Gender:M
Credentials:DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 S WESTNEDGE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3291
Mailing Address - Country:US
Mailing Address - Phone:269-488-8888
Mailing Address - Fax:
Practice Address - Street 1:4230 S WESTNEDGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3291
Practice Address - Country:US
Practice Address - Phone:269-488-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist