Provider Demographics
NPI:1578544904
Name:SCHWARTZ, DOUGLAS JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOHN
Last Name:SCHWARTZ
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:PO BOX 1334
Mailing Address - Street 2:1204 W 18TH ST
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2817
Mailing Address - Country:US
Mailing Address - Phone:712-264-8829
Mailing Address - Fax:712-264-8849
Practice Address - Street 1:1204 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2817
Practice Address - Country:US
Practice Address - Phone:712-264-8829
Practice Address - Fax:712-264-8849
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223644Medicaid
IA30493OtherBLUE CROSS BLUE SHEILD
IAI8175Medicare ID - Type Unspecified
IA30493OtherBLUE CROSS BLUE SHEILD