Provider Demographics
NPI:1073954269
Name:CONWAY INJURY CENTER INC
Entity Type:Organization
Organization Name:CONWAY INJURY CENTER INC
Other - Org Name:CROWN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:LENOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-205-1933
Mailing Address - Street 1:2915 DAVE WARD DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2915 DAVE WARD DR
Practice Address - Street 2:SUITE 8
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-9310
Practice Address - Country:US
Practice Address - Phone:501-205-1933
Practice Address - Fax:501-358-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty