Provider Demographics
NPI:1518979277
Name:SWEDE, DOUGLAS R (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:SWEDE
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 1:130 W MAIN ST
Mailing Address - Street 2:PMB312 SUITE 144
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2025
Mailing Address - Country:US
Mailing Address - Phone:610-831-1650
Mailing Address - Fax:610-831-1651
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-2025
Practice Address - Country:US
Practice Address - Phone:610-831-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-008938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50033215OtherPA BLUE SHIELD
PA1432704OtherHIGHMARK BLUE CROSS
PA2117389000OtherINDEPENDENCE BLUE CROSS
PA2833386000OtherKHPE/BC
PA3227538OtherAETNA