Provider Demographics
NPI:1568592889
Name:WASWICK, JAMES HAROLD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HAROLD
Last Name:WASWICK
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 1:6491B SAN RU
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428
Mailing Address - Country:US
Mailing Address - Phone:616-669-8880
Mailing Address - Fax:616-669-2241
Practice Address - Street 1:6491B SAN RU AVE
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8185
Practice Address - Country:US
Practice Address - Phone:616-669-8880
Practice Address - Fax:616-669-2241
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2969826Medicaid
MI2969826Medicaid
U36470Medicare UPIN