Provider Demographics
NPI:1255398038
Name:SWICKARD, MARK ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:SWICKARD
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 1:17202 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-8901
Mailing Address - Country:US
Mailing Address - Phone:913-268-8300
Mailing Address - Fax:913-268-8390
Practice Address - Street 1:17202 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-8901
Practice Address - Country:US
Practice Address - Phone:913-268-8300
Practice Address - Fax:913-268-8390
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS16902011OtherBLUE CROSS BLUE SHIELD
KS16902011OtherBLUE CROSS BLUE SHIELD
KSU08741Medicare UPIN