Provider Demographics
NPI:1720059512
Name:SWETMAN, RICHARD D (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:SWETMAN
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 1:7207 265TH ST NW
Mailing Address - Street 2:#102
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292
Mailing Address - Country:US
Mailing Address - Phone:360-629-4529
Mailing Address - Fax:360-629-4520
Practice Address - Street 1:7207 265TH ST NW
Practice Address - Street 2:#102
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292
Practice Address - Country:US
Practice Address - Phone:360-629-4529
Practice Address - Fax:360-629-4520
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000644Medicaid
WAG001201224Medicare ID - Type Unspecified
WA2000644Medicaid