Provider Demographics
NPI:1952558009
Name:SWICK CHIROPRACTIC OFFICE, LLC
Entity Type:Organization
Organization Name:SWICK CHIROPRACTIC OFFICE, LLC
Other - Org Name:SWICK & SWICK CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-655-8008
Mailing Address - Street 1:132 ALBANY ST
Mailing Address - Street 2:ATWELL MILL
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-1231
Mailing Address - Country:US
Mailing Address - Phone:315-655-8008
Mailing Address - Fax:315-655-1070
Practice Address - Street 1:132 ALBANY ST
Practice Address - Street 2:ATWELL MILL
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1231
Practice Address - Country:US
Practice Address - Phone:315-655-8008
Practice Address - Fax:315-655-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54614AOtherPTAN
NY54614AOtherPTAN
NYU46570Medicare UPIN