Healthcare Provider Details

I. General information

NPI: 1114335569
Provider Name (Legal Business Name): NORTH CONWAY CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-5189
US

IV. Provider business mailing address

PO BOX 3
NORTH CONWAY NH
03860-0003
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-2471
  • Fax: 603-356-8759
Mailing address:
  • Phone: 603-356-2471
  • Fax: 603-356-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number012806558401A
License Number StateNH

VIII. Authorized Official

Name: DR. LEO MICHAEL KENNEY
Title or Position: OWNER
Credential: DC
Phone: 603-356-2471