Provider Demographics
NPI:1518018605
Name:SWANSON, CRAIG JAMES (LAC,DIPLAC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:JAMES
Last Name:SWANSON
Suffix:
Gender:M
Credentials:LAC,DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402713
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92340-2713
Mailing Address - Country:US
Mailing Address - Phone:760-241-8229
Mailing Address - Fax:760-243-9590
Practice Address - Street 1:14359 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4209
Practice Address - Country:US
Practice Address - Phone:760-241-8229
Practice Address - Fax:760-243-9590
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6396171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist