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General NPI Number Information
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NPI Number | 1215907274
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Entity Type | Organization
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Legal Business Name | SWIM CHIROPRACTIC CARE CENTER, P.C.
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1207 A AVE E SUITE A
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City | OSKALOOSA
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State | IA
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Zip | 52577-4237
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Country | US
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Telephone | 641-672-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 1207 A AVE E SUITE A
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City | OSKALOOSA
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State | IA
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Zip | 52577-4237
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Country | US
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Telephone | 641-672-1399
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STACY EDGAR SWIM
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Credential | D.C.
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Telephone | 641-672-1399
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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 | A06011
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License Number State | IA
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