Provider Demographics
NPI:1154391423
Name:SCHWIESOW, RYAN PATRICK (DC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:PATRICK
Last Name:SCHWIESOW
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 1:827 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAWARDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51023
Mailing Address - Country:US
Mailing Address - Phone:712-551-4242
Mailing Address - Fax:712-551-4243
Practice Address - Street 1:827 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAWARDEN
Practice Address - State:IA
Practice Address - Zip Code:51023
Practice Address - Country:US
Practice Address - Phone:712-551-4242
Practice Address - Fax:712-551-4243
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02757OtherBCBS
IA0197889Medicaid
SD7601240OtherSD MEDICAID
IA0197889Medicaid
U77069Medicare UPIN