Provider Demographics
NPI:1063675809
Name:SWELLA CLINIC OF CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:SWELLA CLINIC OF CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SWELLA SMEDSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-382-3801
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15201OtherWELLMARK
IA1811977473OtherNPI INDIVIDUAL
IA15201Medicare UPIN