Provider Demographics
NPI:1033288956
Name:SWETLIC, JAMES A (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:SWETLIC
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 1:11 WOODLAKE TRL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-8113
Mailing Address - Country:US
Mailing Address - Phone:740-392-1407
Mailing Address - Fax:
Practice Address - Street 1:11 WOODLAKE TRL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8113
Practice Address - Country:US
Practice Address - Phone:740-392-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC1259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0720152Medicaid
OHT48621Medicare UPIN
OH0603151Medicare ID - Type Unspecified