Provider Demographics
NPI:1932329752
Name:DR. DOUGLAS R. SWEDE DC LLC
Entity Type:Organization
Organization Name:DR. DOUGLAS R. SWEDE DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:SWEDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-831-1650
Mailing Address - Street 1:130 W MAIN ST
Mailing Address - Street 2:PMB312 SUITE 144
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2025
Mailing Address - Country:US
Mailing Address - Phone:610-831-1650
Mailing Address - Fax:610-831-1651
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:SUITE 126
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-2025
Practice Address - Country:US
Practice Address - Phone:610-831-1650
Practice Address - Fax:610-831-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1432704OtherHIGHMARK BLUE SHEILD
PA2833386000OtherKHPE
PA2117389000OtherINDEPENDANCE BLUE CROSS
PA7772422OtherAETNA
PA2833386000OtherKHPE