Provider Demographics
NPI:1639259211
Name:SWICK, CHARLES THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:SWICK
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 1:132 ALBANY ST
Mailing Address - Street 2:ATWELL MILL
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-1231
Mailing Address - Country:US
Mailing Address - Phone:315-655-8008
Mailing Address - Fax:315-655-1070
Practice Address - Street 1:132 ALBANY ST
Practice Address - Street 2:ATWELL MILL
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1231
Practice Address - Country:US
Practice Address - Phone:315-655-8008
Practice Address - Fax:315-655-1070
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54614BMedicare ID - Type Unspecified
NYU46570Medicare UPIN