Provider Demographics
NPI:1114217627
Name:SWINNEY, CHRISTOPHER WAYNE (IDC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:SWINNEY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMLOGWESTPAC MAS
Mailing Address - Street 2:477-1 DURBAN ROAD
Mailing Address - City:SINGAPORE
Mailing Address - State:SINGAPORE
Mailing Address - Zip Code:759641
Mailing Address - Country:SG
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 FARENHOLT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:518-490-1718
Practice Address - Fax:518-490-1718
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman