Healthcare Provider Details

I. General information

NPI: 1588193403
Provider Name (Legal Business Name): MARK G. SCHWEITZER DC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N GRAND AVE STE 12
FORT THOMAS KY
41075-1755
US

IV. Provider business mailing address

20 N GRAND AVE STE 12
FORT THOMAS KY
41075-1755
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4150
License Number StateKY

VIII. Authorized Official

Name: DR. MARK G SCHWEITZER
Title or Position: PRESIDENT
Credential: DC
Phone: 859-441-8800