=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710006804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWIESZ FAMILY CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 SANDOWN RD UNIT 1
-----------------------------------------------------
City | EAST HAMPSTEAD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03826-5411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-329-5491
-----------------------------------------------------
Fax | 603-329-5907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 SANDOWN RD UNIT 1
-----------------------------------------------------
City | EAST HAMPSTEAD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03826-5411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-329-5491
-----------------------------------------------------
Fax | 603-329-5907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | MATTHEW SWIESZ
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 603-329-5491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 590-0200
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 589-0200
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------