Healthcare Provider Details

I. General information

NPI: 1851250401
Provider Name (Legal Business Name): ETHAN CONWAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8323 W LAWRENCE AVE STE AB
NORRIDGE IL
60706-3118
US

IV. Provider business mailing address

8323 W LAWRENCE AVE STE AB
NORRIDGE IL
60706-3118
US

V. Phone/Fax

Practice location:
  • Phone: 708-457-8000
  • Fax:
Mailing address:
  • Phone: 708-457-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038014418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: