Provider Demographics
NPI:1508896655
Name:SCHWERDTFAGER, ALVIN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:RAY
Last Name:SCHWERDTFAGER
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 1:136 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456-2227
Mailing Address - Country:US
Mailing Address - Phone:785-227-2633
Mailing Address - Fax:785-227-4193
Practice Address - Street 1:136 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456-2227
Practice Address - Country:US
Practice Address - Phone:785-227-2633
Practice Address - Fax:785-227-4193
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03688207R00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007203OtherBCBS PN FOR LINDSBORG
KS01-03688OtherSTATE CERTIFICATE NUMBER
KS023728OtherBCBS PN FOR SALINA OFFICE
KS01-03688OtherSTATE CERTIFICATE NUMBER
KS023728OtherBCBS PN FOR SALINA OFFICE
KS007203Medicare ID - Type UnspecifiedPN FOR LINDSBORG OFFICE