Healthcare Provider Details

I. General information

NPI: 1164106563
Provider Name (Legal Business Name): CONWAY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 E SOUTHERN AVE STE A105
MESA AZ
85206-2509
US

IV. Provider business mailing address

3614 E SOUTHERN AVE STE A105
MESA AZ
85206-2509
US

V. Phone/Fax

Practice location:
  • Phone: 480-863-3448
  • Fax: 480-863-6202
Mailing address:
  • Phone: 480-863-3448
  • Fax: 480-863-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON R CONWAY
Title or Position: OWNER
Credential: DC
Phone: 480-747-3102