Provider Demographics
NPI:1619052735
Name:SWISTAK, GREGORY CLARK (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CLARK
Last Name:SWISTAK
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 1:187 CHEVY CHASE ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6466
Mailing Address - Country:US
Mailing Address - Phone:301-518-2622
Mailing Address - Fax:
Practice Address - Street 1:60 MARKET ST
Practice Address - Street 2:215
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6548
Practice Address - Country:US
Practice Address - Phone:301-963-8333
Practice Address - Fax:301-963-9330
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ9770001OtherBCBS
MD1ST HEALTHOtherP3449828
MD606996-02189BOtherBCBS
MD10435522OtherCAQH
MD624464OtherMAMSI
MD224657OtherKAISER/ACN
MD3638973OtherAETNA HMO
MD7662053OtherAETNA PPO
MD224657OtherKAISER/ACN
DCJ9770001OtherBCBS