Provider Demographics
NPI:1326210337
Name:J.C. SWINK CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:J.C. SWINK CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:C
Authorized Official - Last Name:SWINK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-764-9054
Mailing Address - Street 1:31532 RAILROAD CANYON RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9437
Mailing Address - Country:US
Mailing Address - Phone:951-764-9054
Mailing Address - Fax:
Practice Address - Street 1:31532 RAILROAD CANYON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9437
Practice Address - Country:US
Practice Address - Phone:951-764-9054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0240030Medicare PIN