Organization Active NPI

Southpointe Chiropractic and Fitness

  • Sports Physician Chiropractor
  • Canonsburg, PA
National Provider Identifier
1972629236
Registry record updated Feb 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
DC007385L Issued in PA
Legal business name
SOUTHPOINTE CHIROPRACTIC AND FITNESS
Practice address
673 Morganza Rd Ste 105
Canonsburg, PA 15317-5715
Phone
(724) 873-0700
NPI assigned
Mar 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tyson Thomas Swigart, DCNPI 1174585616
Title
Owner
Phone
(724) 873-0700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NS0005X DC007385L PA Primary

Addresses

Primary practice location

673 Morganza Rd Ste 105
Canonsburg, PA 15317-5715

Mailing address

673 Morganza Rd Ste 105
Canonsburg, PA 15317-5715
Phone (724) 873-0700

Other identifiers 1

IdentifierTypeStateIssuer
001734932MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040510000625 PA Part B Supplier - Clinic/Group Practice 3971592510 Receives reassigned benefits from 1 practitioner
Practice locations: Canonsburg, PA

National Provider Directory

National Provider Directory

Locations

673 Morganza Rd
Ste 105
Canonsburg, PA 15317
Phone (724) 873-0700

380 Southpointe Blvd
Ste 105
Canonsburg, PA 15317
Phone (724) 873-0700

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1972629236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673 MORGANZA RD STE 105",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153175715",
            "telephone_number": "724-873-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "673 MORGANZA RD STE 105",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153175715",
            "telephone_number": "724-873-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPOINTE CHIROPRACTIC AND FITNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "SWIGART",
        "authorized_official_first_name": "TYSON",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-873-0700",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "PA",
            "license": "DC007385L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001734932",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canonsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.