Provider Demographics
NPI:1215130380
Name:SWICKARD CHIROPRACTIC CLINIC, PC
Entity type:Organization
Organization Name:SWICKARD CHIROPRACTIC CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SWICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-452-0500
Mailing Address - Street 1:2518 NE 43RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-2449
Mailing Address - Country:US
Mailing Address - Phone:916-452-0500
Mailing Address - Fax:816-452-0565
Practice Address - Street 1:2518 NE 43RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-2449
Practice Address - Country:US
Practice Address - Phone:916-452-0500
Practice Address - Fax:816-452-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE003047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790732121OtherUPI NUMBER
MOT73618Medicare UPIN
MO0002655Medicare PIN