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General NPI Number Information
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NPI Number | 1053576249
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Entity Type | Organization
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Legal Business Name | MARA G SCHWARTZ DC PC
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 114 WELLWOOD DR
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-2353
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Country | US
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Telephone | 315-637-4145
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Fax |
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Provider Business Mailing Address
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Address Line | 114 WELLWOOD DR
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-2353
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Country | US
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Telephone | 315-637-4145
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MARA G SCHWARTZ
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Credential | DC
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Telephone | 315-637-4145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X007994-1
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License Number State | NY
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