Provider Demographics
NPI:1992872543
Name:SWALES, THAD ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:THAD
Middle Name:ROBERT
Last Name:SWALES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 PICKERING ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1243
Mailing Address - Country:US
Mailing Address - Phone:814-849-3331
Mailing Address - Fax:814-849-4177
Practice Address - Street 1:93 PICKERING ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1243
Practice Address - Country:US
Practice Address - Phone:814-849-3331
Practice Address - Fax:814-849-4177
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004079L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011828840002Medicaid
PA0011828840002Medicaid