Organization Active NPI

Jeffrey a Conn DC PC

  • Chiropractor
  • Clinton TWP, MI
National Provider Identifier
1417071655
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
JEFFREY A CONN DC PC
Practice address
20742 Hall Rd
Clinton TWP, MI 48038-1537
Phone
(586) 468-4461
Fax
(586) 468-3636
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeffrey Allen Conn, D.C.NPI 1780715995
Title
President
Phone
(586) 468-4461

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

20742 Hall Rd
Clinton TWP, MI 48038-1537

Mailing address

20742 Hall Rd
Clinton TWP, MI 48038-1537
Phone (586) 468-4461

Other identifiers 1

IdentifierTypeStateIssuer
95-0-E0-1939-0OtherMIBLUE CROSS BLUE SHIELD

Other names 1

  • Pointe Village Chiropractic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070925000084 MI Part B Supplier - Clinic/Group Practice 5395839518 Receives reassigned benefits from 2 practitioners
Practice locations: Clinton Township, MI

National Provider Directory

National Provider Directory

Locations

20742 Hall Rd
Clinton Twp, MI 48038
Phone (586) 468-4461

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1417071655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20742 HALL RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381537",
            "telephone_number": "586-468-4461",
            "fax_number": "586-468-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20742 HALL RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381537",
            "telephone_number": "586-468-4461",
            "fax_number": "586-468-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY A CONN DC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "CONN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-468-4461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "95-0-E0-1939-0",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pointe Village Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton TWP, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.