Provider Demographics
NPI:1467840769
Name:SWANN MEDICAL
Entity Type:Organization
Organization Name:SWANN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:O'HARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-923-5315
Mailing Address - Street 1:2111 W SWANN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2477
Mailing Address - Country:US
Mailing Address - Phone:813-253-5969
Mailing Address - Fax:813-253-5848
Practice Address - Street 1:2111 W SWANN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2477
Practice Address - Country:US
Practice Address - Phone:813-253-5969
Practice Address - Fax:813-253-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9435111N00000X
FLCH11379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty