Provider Demographics
NPI:1598455727
Name:SWAN CITY CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:SWAN CITY CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-529-8940
Mailing Address - Street 1:3217 CARLETON CIR E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4546
Mailing Address - Country:US
Mailing Address - Phone:256-529-8940
Mailing Address - Fax:
Practice Address - Street 1:3242 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4574
Practice Address - Country:US
Practice Address - Phone:863-682-4182
Practice Address - Fax:863-644-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty