Provider Demographics
NPI:1851580864
Name:SWEIS, MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:SWEIS
Suffix:
Gender:F
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:PO BOX 2542
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-2542
Mailing Address - Country:US
Mailing Address - Phone:708-372-2008
Mailing Address - Fax:
Practice Address - Street 1:1151 ROBERT GRISSOM PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5664
Practice Address - Country:US
Practice Address - Phone:708-372-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3654111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
O05042012000157OtherMEDICARE ENROLMENT ID