Provider Demographics
NPI:1083628960
Name:SWANK, TIMOTHY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:SWANK
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 1:3731 NW CARY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8436
Mailing Address - Country:US
Mailing Address - Phone:919-460-6098
Mailing Address - Fax:919-460-6099
Practice Address - Street 1:3731 NW CARY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8436
Practice Address - Country:US
Practice Address - Phone:919-460-6098
Practice Address - Fax:919-460-6099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08532OtherBCBSNC ID #
NC2446428Medicare ID - Type Unspecified