Provider Demographics
NPI:1306126099
Name:SCHWIETERT CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:SCHWIETERT CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHWIETERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-342-0748
Mailing Address - Street 1:814 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3541
Mailing Address - Country:US
Mailing Address - Phone:605-342-0748
Mailing Address - Fax:605-342-0769
Practice Address - Street 1:814 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3541
Practice Address - Country:US
Practice Address - Phone:605-342-0748
Practice Address - Fax:605-342-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1508891391OtherINDIVIDUAL NPI NUMBER
SDT66523Medicare UPIN