Provider Demographics
NPI:1093010316
Name:SWENSEN, JUDD M (DC)
Entity Type:Individual
Prefix:
First Name:JUDD
Middle Name:M
Last Name:SWENSEN
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 1:114 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175-1329
Mailing Address - Country:US
Mailing Address - Phone:563-422-5771
Mailing Address - Fax:
Practice Address - Street 1:114 E ELM ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1329
Practice Address - Country:US
Practice Address - Phone:563-422-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2238001Medicare PIN