Healthcare Provider Details

I. General information

NPI: 1942293212
Provider Name (Legal Business Name): GREGORY WAYNE SWARTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 E 6TH ST
GILLETTE WY
82716-4041
US

IV. Provider business mailing address

814 E 6TH ST
GILLETTE WY
82716-4041
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-3013
  • Fax: 307-686-2350
Mailing address:
  • Phone: 307-682-3013
  • Fax: 307-686-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number545
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: