Healthcare Provider Details

I. General information

NPI: 1548451354
Provider Name (Legal Business Name): TRAVIS MICHAEL CONLEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 DUPONT DR STE 101
IRVINE CA
92612-1315
US

IV. Provider business mailing address

2152 DUPONT DR STE 101
IRVINE CA
92612-1315
US

V. Phone/Fax

Practice location:
  • Phone: 949-228-5820
  • Fax:
Mailing address:
  • Phone: 949-228-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number29811
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number29811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: