Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2843 | IA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2843 | IA |
NPI | 1326001827 |
---|---|
Provider Name | Dr. Conway Chin |
First Address | Eldridge, IA 52748 |
Second Address | Eldridge, IA 52748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0223891 | (05) | IA |
G01299 | (02) |