Provider Demographics
NPI:1235487109
Name:SWAN, JASON STUART (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:STUART
Last Name:SWAN
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 1:211 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1617
Mailing Address - Country:US
Mailing Address - Phone:810-658-7926
Mailing Address - Fax:810-653-4186
Practice Address - Street 1:211 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1617
Practice Address - Country:US
Practice Address - Phone:810-658-7926
Practice Address - Fax:810-653-4186
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-26
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor