Provider Demographics
NPI:1811977473
Name:SWELLA SMEDSRUD, REBECCA J (DC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:SWELLA SMEDSRUD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2146
Mailing Address - Country:US
Mailing Address - Phone:563-382-3801
Mailing Address - Fax:563-387-0004
Practice Address - Street 1:810 S MECHANIC ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2146
Practice Address - Country:US
Practice Address - Phone:563-382-3801
Practice Address - Fax:563-387-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
15201OtherWELLMARK I.D. NO.
IAA05780OtherCHIROPRACTIC LICENSE NO.
IAA05780OtherCHIROPRACTIC LICENSE NO.