Provider Demographics
NPI:1336323773
Name:SWAIN, JUDITH ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELIZABETH
Last Name:SWAIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3508
Mailing Address - Country:US
Mailing Address - Phone:651-340-9779
Mailing Address - Fax:
Practice Address - Street 1:5313 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1229
Practice Address - Country:US
Practice Address - Phone:612-822-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor