Provider Demographics
NPI:1265672364
Name:SWARNER, WILLIAM EUGENE (LMT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:SWARNER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N MILWAUKEE AVE APT C12
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8901
Mailing Address - Country:US
Mailing Address - Phone:224-234-4667
Mailing Address - Fax:
Practice Address - Street 1:103 N MILWAUKEE AVE APT C12
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8901
Practice Address - Country:US
Practice Address - Phone:224-234-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227.009878OtherILLINOIS LICENSE NUMBER