Provider Demographics
NPI:1508803651
Name:CONWAY, JASON R (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:CONWAY
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 1:5705 E HAMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6746
Mailing Address - Country:US
Mailing Address - Phone:480-747-3102
Mailing Address - Fax:
Practice Address - Street 1:3614 E SOUTHERN AVE # A-105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2509
Practice Address - Country:US
Practice Address - Phone:480-863-3448
Practice Address - Fax:480-863-6202
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7205204OtherAETNA PROVIDER
AZ8011OtherLICENSE#
AZAZ0937301OtherBCBS PROVIDER NO
AZ3784OtherPHYSIO THERAPY LICENSE#
AZ3784OtherPHYSIO THERAPY LICENSE#