Provider Demographics
NPI:1285845842
Name:SCHWARZ, KENNETH THEODORE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:THEODORE
Last Name:SCHWARZ
Suffix:JR
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 1:4720 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-5007
Mailing Address - Country:US
Mailing Address - Phone:774-619-1111
Mailing Address - Fax:772-461-9111
Practice Address - Street 1:4720 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-5007
Practice Address - Country:US
Practice Address - Phone:774-619-1111
Practice Address - Fax:772-461-9111
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70936Medicare ID - Type Unspecified