Provider Demographics
NPI:1093839698
Name:SWINK, JEFF C (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:C
Last Name:SWINK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:C
Other - Last Name:SWINK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:31532 RAILROAD CANYON RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9437
Mailing Address - Country:US
Mailing Address - Phone:951-244-4040
Mailing Address - Fax:951-244-6622
Practice Address - Street 1:31532 RAILROAD CANYON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9437
Practice Address - Country:US
Practice Address - Phone:951-244-4040
Practice Address - Fax:951-244-6622
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91-1890141OtherFEDERAL EIN
CADC0240030Medicare ID - Type UnspecifiedMEDICARE ID NUMBER