Provider Demographics
NPI:1003960691
Name:SWANSON, JUSTIN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MATTHEW
Last Name:SWANSON
Suffix:
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 1:3703 CALIFORNIA AVE SW
Mailing Address - Street 2:SUITE A/B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3771
Mailing Address - Country:US
Mailing Address - Phone:206-937-3965
Mailing Address - Fax:206-937-4695
Practice Address - Street 1:3703 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE A/B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3771
Practice Address - Country:US
Practice Address - Phone:206-937-3965
Practice Address - Fax:206-937-4695
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor