Provider Demographics
NPI:1407944291
Name:CONVERY, JAMES J (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:CONVERY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1908
Mailing Address - Country:US
Mailing Address - Phone:508-756-6841
Mailing Address - Fax:508-754-9145
Practice Address - Street 1:877 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-1908
Practice Address - Country:US
Practice Address - Phone:508-756-6841
Practice Address - Fax:508-754-9145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADC2031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1610139Medicaid
MA1610139Medicaid
MAY45061Medicare ID - Type Unspecified