Provider Demographics
NPI:1902298201
Name:CONFLITTI, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CONFLITTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28107 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2810
Mailing Address - Country:US
Mailing Address - Phone:248-542-3492
Mailing Address - Fax:248-542-3494
Practice Address - Street 1:28107 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071
Practice Address - Country:US
Practice Address - Phone:248-425-3492
Practice Address - Fax:248-542-3494
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015002909111N00000X
PADC011015111N00000X
MI2301010294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor