Provider Demographics
NPI:1558362483
Name:SWAYZE, CHARLES P (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:SWAYZE
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 1:402 W CANFIELD AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7784
Mailing Address - Country:US
Mailing Address - Phone:208-762-9000
Mailing Address - Fax:
Practice Address - Street 1:402 W CANFIELD AVE
Practice Address - Street 2:STE 3
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7784
Practice Address - Country:US
Practice Address - Phone:208-762-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-09-21
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805528100Medicaid
IDU74766Medicare UPIN
ID805528100Medicaid