Provider Demographics
NPI:1891818621
Name:CONWAY, MICHAEL F (ND)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:CONWAY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3606 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2257
Mailing Address - Country:US
Mailing Address - Phone:360-695-7699
Mailing Address - Fax:360-695-1503
Practice Address - Street 1:3606 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2257
Practice Address - Country:US
Practice Address - Phone:360-695-7699
Practice Address - Fax:360-695-1503
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000960175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230611Medicare UPIN