Provider Demographics
NPI:1437861028
Name:SCHWEM, JACK THOMAS GALLAGHER (MAC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:THOMAS GALLAGHER
Last Name:SCHWEM
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W KAGY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6052
Mailing Address - Country:US
Mailing Address - Phone:406-599-0088
Mailing Address - Fax:
Practice Address - Street 1:81 W KAGY BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6052
Practice Address - Country:US
Practice Address - Phone:406-599-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT118051171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist