Provider Demographics
NPI:1265629356
Name:SWETLIC CHIROPRACTIC & REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:SWETLIC CHIROPRACTIC & REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWETLIC
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:740-392-1407
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:740-392-0334
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:740-392-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4549474OtherAETNA LIFE CASUALTY
OH000000119111OtherBLUE CROSS BLUE SHEILD
OH295643739002OtherMEDICAL MUTUAL
OH0720152Medicaid
ORP00301046OtherRAIL ROAD MEDICARE
OH295643739002OtherMEDICAL MUTUAL
OH0603151Medicare PIN
OH6077950001Medicare NSC