Provider Demographics
NPI:1588608467
Name:SCHWARTZ, GREGG M (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:M
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 1:100 HARBOB LANE
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454
Mailing Address - Country:US
Mailing Address - Phone:215-362-7777
Mailing Address - Fax:215-393-9501
Practice Address - Street 1:100 HARBOB LANE
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454
Practice Address - Country:US
Practice Address - Phone:215-362-7777
Practice Address - Fax:215-393-9501
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003785L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0880462000OtherKEYSTONE
PA0421203000OtherBCBS
PASC598798Medicare ID - Type Unspecified
PA0421203000OtherBCBS