Provider Demographics
NPI:1336213479
Name:SWISTAK CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SWISTAK CHIROPRACTIC PC
Other - Org Name:ACTIVE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:SWISTAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-963-8333
Mailing Address - Street 1:60 MARKET ST
Mailing Address - Street 2:215
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6548
Mailing Address - Country:US
Mailing Address - Phone:301-963-8333
Mailing Address - Fax:301-963-9330
Practice Address - Street 1:60 MARKET ST
Practice Address - Street 2:215
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6548
Practice Address - Country:US
Practice Address - Phone:301-963-8333
Practice Address - Fax:301-963-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD224657OtherKAISER
MD3449828Other1ST HEALTH
MD606996-02OtherBCBSMD
MD7662053OtherAETNA PPO
MD3638973OtherAETNA HMO
DC9770001OtherBCBS FED
MDFIRST HEALTHOther5544592
MDG01809S01Medicare ID - Type Unspecified