Provider Demographics
NPI:1003886433
Name:SWAIN, RUSSELL THYRL III (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:THYRL
Last Name:SWAIN
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11590 BLACK FOREST RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-6000
Mailing Address - Country:US
Mailing Address - Phone:719-494-0900
Mailing Address - Fax:719-494-0901
Practice Address - Street 1:11590 BLACK FOREST RD
Practice Address - Street 2:SUITE 20
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-6000
Practice Address - Country:US
Practice Address - Phone:719-494-0900
Practice Address - Fax:719-494-0901
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5636111N00000X
FLCH7244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU70792Medicare UPIN
CO803501Medicare ID - Type UnspecifiedNORIDIAN MEDICARE #