Provider Demographics
NPI:1235311812
Name:SWANSON, CHESTER ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:ANDREW
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 1188
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-1188
Mailing Address - Country:US
Mailing Address - Phone:360-297-4544
Mailing Address - Fax:360-297-7657
Practice Address - Street 1:10978 STATE HWY 104
Practice Address - Street 2:SUITE #125
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-1188
Practice Address - Country:US
Practice Address - Phone:360-297-4544
Practice Address - Fax:360-297-7657
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor