Provider Demographics
NPI:1326275546
Name:SWETLIC CHIROPRACTIC AND JAMES ALLEN SWETLIC SOLE MBR
Entity Type:Organization
Organization Name:SWETLIC CHIROPRACTIC AND JAMES ALLEN SWETLIC SOLE MBR
Other - Org Name:SWETLIC CHIROPRACTIC & REHABILITATION CENTER OF LANCASTER, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SWETLIC
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:740-392-1407
Mailing Address - Street 1:2217 W FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8821
Mailing Address - Country:US
Mailing Address - Phone:740-687-2225
Mailing Address - Fax:740-687-2231
Practice Address - Street 1:2217 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8821
Practice Address - Country:US
Practice Address - Phone:740-687-2225
Practice Address - Fax:740-687-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2851409Medicaid
OH2851409Medicaid