Provider Demographics
NPI:1316067010
Name:SWAYZE CHIROPRACTIC PC
Entity type:Organization
Organization Name:SWAYZE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES P SWAYZE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SWAYZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-762-9000
Mailing Address - Street 1:402 W CANFIELD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7784
Mailing Address - Country:US
Mailing Address - Phone:208-762-9000
Mailing Address - Fax:208-762-9009
Practice Address - Street 1:402 W CANFIELD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7784
Practice Address - Country:US
Practice Address - Phone:208-762-9000
Practice Address - Fax:208-762-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805528100Medicaid
IDU74766Medicare UPIN
ID1376605Medicare PIN