Provider Demographics
NPI:1538680699
Name:CONWAY HEALTH CARE & REHAB LLC
Entity Type:Organization
Organization Name:CONWAY HEALTH CARE & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:KUDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-954-3312
Mailing Address - Street 1:11945 GRANDHAVEN DR STE F
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8091
Mailing Address - Country:US
Mailing Address - Phone:609-954-3312
Mailing Address - Fax:843-347-1824
Practice Address - Street 1:11945 GRANDHAVEN DR STE F
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8091
Practice Address - Country:US
Practice Address - Phone:843-357-7200
Practice Address - Fax:843-347-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty