=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386102325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWEDE STREET CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2019
-----------------------------------------------------
Last Update Date | 03/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 E MAIN ST STE 309
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19401-4913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-277-7520
-----------------------------------------------------
Fax | 610-277-8450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 E MAIN ST STE 309
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19401-4913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-277-7520
-----------------------------------------------------
Fax | 610-277-8450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. JOHN SZOSTEK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 610-564-9185
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------