Provider Demographics
NPI:1407833817
Name:SCHWANZ, JON W (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:W
Last Name:SCHWANZ
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 1:1222 PRAY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-8717
Mailing Address - Country:US
Mailing Address - Phone:419-878-8142
Mailing Address - Fax:419-878-8143
Practice Address - Street 1:1222 PRAY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-8717
Practice Address - Country:US
Practice Address - Phone:419-878-8142
Practice Address - Fax:419-878-8143
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1201111N00000X, 111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0632855Medicaid
OH341973220OtherTIN
OH0632855Medicaid
OHSC0582532Medicare ID - Type UnspecifiedMEDICARE