Provider Demographics
NPI:1962260828
Name:CONLEY, ADAM JOSEPH (LMT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSEPH
Last Name:CONLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6094 COVENTRY WOODS DR NE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8725
Mailing Address - Country:US
Mailing Address - Phone:616-240-0016
Mailing Address - Fax:
Practice Address - Street 1:6810 OLD 28TH ST SE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6932
Practice Address - Country:US
Practice Address - Phone:616-570-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist