Provider Demographics
NPI:1275512527
Name:SCHWARTZ, DAVID ETHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ETHAN
Last Name:SCHWARTZ
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:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0060
Mailing Address - Country:US
Mailing Address - Phone:919-934-2247
Mailing Address - Fax:919-934-2247
Practice Address - Street 1:612 S BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4446
Practice Address - Country:US
Practice Address - Phone:919-934-2247
Practice Address - Fax:919-934-2247
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0833FOtherBCBS
NC890833FMedicaid
NC890833FMedicaid
NC0833FOtherBCBS