1336213479 NPI number — SWISTAK CHIROPRACTIC PC

Table of content: (NPI 1336213479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336213479 NPI number — SWISTAK CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWISTAK CHIROPRACTIC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACTIVE FAMILY CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336213479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 MARKET ST
Provider Second Line Business Mailing Address:
215
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-6548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-963-8333
Provider Business Mailing Address Fax Number:
301-963-9330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 MARKET ST
Provider Second Line Business Practice Location Address:
215
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878-6548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-963-8333
Provider Business Practice Location Address Fax Number:
301-963-9330
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWISTAK
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-963-8333

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  S01873 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 224657 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3449828 . This is a "1ST HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 606996-02 . This is a "BCBSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7662053 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3638973 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9770001 . This is a "BCBS FED" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: FIRST HEALTH . This is a "5544592" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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