Provider Demographics
NPI:1669088514
Name:SWAG WELL1 LLC
Entity type:Organization
Organization Name:SWAG WELL1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-437-3414
Mailing Address - Street 1:1417 FM 1463 RD STE 140
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5456
Mailing Address - Country:US
Mailing Address - Phone:832-437-3414
Mailing Address - Fax:832-201-7272
Practice Address - Street 1:1417 FM 1463 RD STE 140
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5456
Practice Address - Country:US
Practice Address - Phone:832-437-3414
Practice Address - Fax:832-201-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty