Healthcare Provider Details

I. General information

NPI: 1700177276
Provider Name (Legal Business Name): JACOB M CONWAY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WATER ST S
NORTHFIELD MN
55057-2040
US

IV. Provider business mailing address

150 WATER ST S
NORTHFIELD MN
55057-2040
US

V. Phone/Fax

Practice location:
  • Phone: 507-645-8000
  • Fax:
Mailing address:
  • Phone: 507-645-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9PDKL5HT
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: