Provider Demographics
NPI:1144387903
Name:SWICKARD CHIROPRACTIC CLINIC, CHARTERED
Entity Type:Organization
Organization Name:SWICKARD CHIROPRACTIC CLINIC, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SWICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-897-6717
Mailing Address - Street 1:15050 ANTIOCH ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221
Mailing Address - Country:US
Mailing Address - Phone:913-897-6717
Mailing Address - Fax:913-897-6795
Practice Address - Street 1:15050 ANTIOCH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-8502
Practice Address - Country:US
Practice Address - Phone:913-897-6717
Practice Address - Fax:913-897-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU16458 KSMedicare UPIN
KSW630000Medicare PIN