Provider Demographics
NPI:1427923887
Name:SWAN CITY WELLNESS LLC
Entity type:Organization
Organization Name:SWAN CITY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-777-1984
Mailing Address - Street 1:1102 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1308
Mailing Address - Country:US
Mailing Address - Phone:863-777-1984
Mailing Address - Fax:
Practice Address - Street 1:1102 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1308
Practice Address - Country:US
Practice Address - Phone:863-777-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty