Provider Demographics
NPI:1588802250
Name:CHIROPRACTIC CARE CENTER, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWIGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-377-3655
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:STAPLETON
Mailing Address - State:AL
Mailing Address - Zip Code:36578-0656
Mailing Address - Country:US
Mailing Address - Phone:251-377-3655
Mailing Address - Fax:
Practice Address - Street 1:830 D'OLIVE STREET
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507
Practice Address - Country:US
Practice Address - Phone:251-580-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty