Provider Demographics
NPI:1326001827
Name:CHIN, CONWAY (DO)
Entity Type:Individual
Prefix:DR
First Name:CONWAY
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748
Mailing Address - Country:US
Mailing Address - Phone:563-285-1380
Mailing Address - Fax:563-285-1386
Practice Address - Street 1:104 EAST LECLAIRE ROAD
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748
Practice Address - Country:US
Practice Address - Phone:563-285-1380
Practice Address - Fax:563-285-1386
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103691208100000X
IA2843208100000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223891Medicaid
G01299Medicare UPIN
IA0223891Medicaid