Provider Demographics
NPI:1568858900
Name:SWALLEY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SWALLEY CHIROPRACTIC LLC
Other - Org Name:GONSTEAD CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:SWALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-446-0755
Mailing Address - Street 1:1698 HIGHWAY 160 W
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8032
Mailing Address - Country:US
Mailing Address - Phone:803-547-9977
Mailing Address - Fax:803-547-9978
Practice Address - Street 1:1698 HIGHWAY 160 W
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8032
Practice Address - Country:US
Practice Address - Phone:803-547-9977
Practice Address - Fax:803-547-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty