Provider Demographics
NPI:1497723340
Name:SWIHART, TIMOTHY A (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:SWIHART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2050
Mailing Address - Country:US
Mailing Address - Phone:260-489-6019
Mailing Address - Fax:260-489-6136
Practice Address - Street 1:1724 PRAIRIE LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1057
Practice Address - Country:US
Practice Address - Phone:260-489-7949
Practice Address - Fax:260-489-8721
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001362A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN239270BMedicare PIN
IN239270Medicare PIN