MEDICARE: SWICK CHIROPRACTIC OFFICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X007504	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54614A	OTHER	NY	PTAN

General Provider Information

NPI Number	:	1952558009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWICK CHIROPRACTIC OFFICE, LLC

Provider Business Mailing Address
First Line	:	132 ALBANY ST
Second Line	:	ATWELL MILL
City	:	CAZENOVIA
State	:	NY
Zip	:	13035-1231
Country	:	US
Telephone Number	:	315-655-8008
Fax Number	:	315-655-1070

Provider Business Practice Location Address
First Line	:	132 ALBANY ST
Second Line	:	ATWELL MILL
City	:	CAZENOVIA
State	:	NY
Zip	:	13035-1231
Country	:	US
Telephone Number	:	315-655-8008
Fax Number	:	315-655-1070

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES THOMAS SWICK
Credential	:	DC
Telephone Number	:	315-655-8008

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	03/24/2009

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