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General NPI Number Information
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NPI Number | 1336213479
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Entity Type | Organization
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Legal Business Name | SWISTAK CHIROPRACTIC PC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 60 MARKET ST 215
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City | GAITHERSBURG
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State | MD
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Zip | 20878-6548
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Country | US
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Telephone | 301-963-8333
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Fax | 301-963-9330
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Provider Business Mailing Address
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Address Line | 60 MARKET ST 215
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City | GAITHERSBURG
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State | MD
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Zip | 20878-6548
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Country | US
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Telephone | 301-963-8333
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Fax | 301-963-9330
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY CLARK SWISTAK
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Credential | DC
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Telephone | 301-963-8333
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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 | S01873
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License Number State | MD
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