1932329752 NPI number — DR. DOUGLAS R. SWEDE DC LLC

Table of content: (NPI 1932329752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932329752 NPI number — DR. DOUGLAS R. SWEDE DC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DOUGLAS R. SWEDE DC LLC
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:
Provider Other Organization Name Type Code:
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:
1932329752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 W MAIN ST
Provider Second Line Business Mailing Address:
PMB312 SUITE 144
Provider Business Mailing Address City Name:
TRAPPE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19426-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-831-1650
Provider Business Mailing Address Fax Number:
610-831-1651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 126
Provider Business Practice Location Address City Name:
TRAPPE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19426-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-831-1650
Provider Business Practice Location Address Fax Number:
610-831-1651
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SWEDE
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
RONALD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-831-1650

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC008938 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1432704 . This is a "HIGHMARK BLUE SHEILD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2833386000 . This is a "KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2117389000 . This is a "INDEPENDANCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7772422 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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