Provider Demographics
NPI:1114335569
Name:NORTH CONWAY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:NORTH CONWAY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-356-2471
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-0003
Mailing Address - Country:US
Mailing Address - Phone:603-356-2471
Mailing Address - Fax:603-356-8759
Practice Address - Street 1:3316 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5189
Practice Address - Country:US
Practice Address - Phone:603-356-2471
Practice Address - Fax:603-356-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH012806558401A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHT86224Medicare UPIN