Provider Demographics
NPI:1720623713
Name:CONWAY, MALCOLM L JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:L
Last Name:CONWAY
Suffix:JR
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 1:540 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5760
Mailing Address - Country:US
Mailing Address - Phone:570-287-7070
Mailing Address - Fax:570-287-5575
Practice Address - Street 1:540 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5760
Practice Address - Country:US
Practice Address - Phone:570-287-7070
Practice Address - Fax:570-287-5575
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor