Provider Demographics
NPI:1083985105
Name:CONWAY, BRIDGET (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:FOUSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1040 HIGHWAY 3 S
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3088
Mailing Address - Country:US
Mailing Address - Phone:507-645-8000
Mailing Address - Fax:507-645-4400
Practice Address - Street 1:1040 HIGHWAY 3 S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3088
Practice Address - Country:US
Practice Address - Phone:507-645-8000
Practice Address - Fax:507-645-4400
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5597111N00000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist