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1720623713 NPI number — MALCOLM L. CONWAY JR. DC

NPI Number: 1720623713
Health Care Provider/Practitioner: MALCOLM L. CONWAY JR. DC

Information about “1720623713” NPI (MALCOLM L. CONWAY JR. DC) exists in 1720623713 in HTML format HTML  |  1720623713 in plain Text format TXT  |  1720623713 in PDF (Portable Document Format) PDF  |  1720623713 in an XML format XML  formats.

NPI Number : 1720623713 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720623713",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CONWAY",
    "FirstName": "MALCOLM",
    "MiddleName": "L.",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "DC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "540 PIERCE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KINGSTON",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "18704-5760",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "570-287-7070",
    "MailingAddressFaxNumber": "570-287-5575",
    "FirstLinePracticeLocationAddress": "540 PIERCE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KINGSTON",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "18704-5760",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "570-287-7070",
    "PracticeLocationAddressFaxNumber": "570-287-5575",
    "EnumerationDate": "11/13/2019",
    "LastUpdateDate": "11/13/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "DC011432",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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