Provider Demographics
NPI:1063534246
Name:SCHWAB, TONY ALLEN (DC)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:ALLEN
Last Name:SCHWAB
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 1:870 W 9TH ST
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3636
Mailing Address - Country:US
Mailing Address - Phone:310-831-5677
Mailing Address - Fax:310-831-1568
Practice Address - Street 1:870 W 9TH ST
Practice Address - Street 2:STE 103
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3636
Practice Address - Country:US
Practice Address - Phone:310-831-5677
Practice Address - Fax:310-831-1568
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V03741Medicare UPIN