Provider Demographics
NPI:1083704944
Name:SWAN, NATHANIEL J III (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:J
Last Name:SWAN
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:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024
Mailing Address - Country:US
Mailing Address - Phone:425-222-5125
Mailing Address - Fax:425-222-9558
Practice Address - Street 1:33712 SE 43RD ST
Practice Address - Street 2:
Practice Address - City:FALL CITY
Practice Address - State:WA
Practice Address - Zip Code:98024
Practice Address - Country:US
Practice Address - Phone:425-222-5125
Practice Address - Fax:425-222-9558
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA113458OtherDEPT LABOR AND INDUSTRIES
GAB14006Medicare ID - Type Unspecified