Provider Demographics
NPI:1043495492
Name:SWANSON FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:SWANSON FAMILY CHIROPRACTIC P.C.
Other - Org Name:SWANSON FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-796-2060
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-0717
Mailing Address - Country:US
Mailing Address - Phone:903-796-2060
Mailing Address - Fax:903-796-9553
Practice Address - Street 1:806 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3429
Practice Address - Country:US
Practice Address - Phone:903-796-2060
Practice Address - Fax:903-796-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00183UMedicare PIN