Provider Demographics
NPI:1184636888
Name:SWANSON, TREVOR JAMES (DC)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JAMES
Last Name:SWANSON
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-0717
Mailing Address - Country:US
Mailing Address - Phone:903-796-2060
Mailing Address - Fax:903-796-9553
Practice Address - Street 1:806 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3429
Practice Address - Country:US
Practice Address - Phone:903-796-2060
Practice Address - Fax:903-796-9553
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00183UMedicare ID - Type Unspecified