Provider Demographics
NPI:1407124795
Name:SWINFORD, KENNETH WARREN (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WARREN
Last Name:SWINFORD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:WARREN
Other - Last Name:SWINFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:18920 BOTHELL WAY NE
Mailing Address - Street 2:#100
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011
Mailing Address - Country:US
Mailing Address - Phone:425-486-1122
Mailing Address - Fax:425-487-6818
Practice Address - Street 1:14090 FRYELANDS BLVD
Practice Address - Street 2:#274
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:360-805-0112
Practice Address - Fax:425-487-6818
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60249597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8906271Medicare PIN