Provider Demographics
NPI:1629131891
Name:WASWICK, GERALD MILTON I (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MILTON
Last Name:WASWICK
Suffix:I
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 1:10 NORTH MAIN STREET BOX 147
Mailing Address - Street 2:
Mailing Address - City:GWINNER
Mailing Address - State:ND
Mailing Address - Zip Code:58040-0147
Mailing Address - Country:US
Mailing Address - Phone:701-678-2431
Mailing Address - Fax:701-678-2431
Practice Address - Street 1:10 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:GWINNER
Practice Address - State:ND
Practice Address - Zip Code:58040-0147
Practice Address - Country:US
Practice Address - Phone:701-678-2431
Practice Address - Fax:701-678-2431
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17793Medicaid
NDN11879Medicare ID - Type Unspecified