Provider Demographics
NPI:1346379245
Name:CONWAY, JAMES RICHARD JR (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:CONWAY
Suffix:JR
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14545 HWY E. RT. 422 BOX 122
Mailing Address - Street 2:
Mailing Address - City:STRONGSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15957-0122
Mailing Address - Country:US
Mailing Address - Phone:814-749-7974
Mailing Address - Fax:814-749-7974
Practice Address - Street 1:14545 HWY E. RT. 422 BOX 122
Practice Address - Street 2:
Practice Address - City:STRONGSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15957-0122
Practice Address - Country:US
Practice Address - Phone:814-749-7974
Practice Address - Fax:814-749-7974
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004484L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACO650499Medicare ID - Type Unspecified