Provider Demographics
NPI:1518006857
Name:SWART, GLENN ERWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ERWIN
Last Name:SWART
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 1:116 W LIME AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2841
Mailing Address - Country:US
Mailing Address - Phone:626-599-8323
Mailing Address - Fax:626-599-8331
Practice Address - Street 1:211 S PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2856
Practice Address - Country:US
Practice Address - Phone:626-359-1135
Practice Address - Fax:626-359-3944
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20420111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU58757Medicare UPIN
CADC20420Medicare ID - Type Unspecified