Provider Demographics
NPI:1417501602
Name:SWIDEREK, RICCI PAIGE (DC)
Entity Type:Individual
Prefix:DR
First Name:RICCI
Middle Name:PAIGE
Last Name:SWIDEREK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 CHARLEVOIX RD STE 19
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8058
Mailing Address - Country:US
Mailing Address - Phone:231-881-9391
Mailing Address - Fax:
Practice Address - Street 1:2780 CHARLEVOIX RD STE 19
Practice Address - Street 2:
Practice Address - City:BAY HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49770-8058
Practice Address - Country:US
Practice Address - Phone:231-881-9391
Practice Address - Fax:231-881-9392
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14504880OtherCAQH