Healthcare Provider Details

I. General information

NPI: 1124103593
Provider Name (Legal Business Name): BROOKE LYNNE PAULEY CONLEY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/09/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 RHODES AVE
NEW BOSTON OH
45662-4915
US

IV. Provider business mailing address

3405 RHODES AVE
NEW BOSTON OH
45662-4915
US

V. Phone/Fax

Practice location:
  • Phone: 740-456-6388
  • Fax: 740-456-6439
Mailing address:
  • Phone: 740-456-6388
  • Fax: 740-456-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: