Provider Demographics
NPI:1306973300
Name:SWIGER, KELLY JO (LMT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:SWIGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2310
Mailing Address - Country:US
Mailing Address - Phone:304-623-7800
Mailing Address - Fax:
Practice Address - Street 1:217 N 27TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2310
Practice Address - Country:US
Practice Address - Phone:304-623-7800
Practice Address - Fax:304-623-0706
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor