Healthcare Provider Details

I. General information

NPI: 1932220134
Provider Name (Legal Business Name): BRAD PATRICK CONLEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PROSPECT AVE
NORTH FOND DU LAC WI
54937-1439
US

IV. Provider business mailing address

401 PROSPECT AVE
NORTH FOND DU LAC WI
54937-1439
US

V. Phone/Fax

Practice location:
  • Phone: 920-906-5070
  • Fax:
Mailing address:
  • Phone: 920-906-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4042-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: