Healthcare Provider Details

I. General information

NPI: 1962260828
Provider Name (Legal Business Name): ADAM JOSEPH CONLEY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 OLD 28TH ST SE STE 3
GRAND RAPIDS MI
49546-6932
US

IV. Provider business mailing address

6094 COVENTRY WOODS DR NE
BELMONT MI
49306-8725
US

V. Phone/Fax

Practice location:
  • Phone: 616-570-0790
  • Fax:
Mailing address:
  • Phone: 616-240-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501014066
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: