Provider Demographics
NPI:1518055128
Name:SWARTHOUT CHIROPRACTIC GROUP, INC.
Entity Type:Organization
Organization Name:SWARTHOUT CHIROPRACTIC GROUP, INC.
Other - Org Name:PACIFIC VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWARTHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-435-9505
Mailing Address - Street 1:8455 N MILLBROOK AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2152
Mailing Address - Country:US
Mailing Address - Phone:559-435-9505
Mailing Address - Fax:559-435-9506
Practice Address - Street 1:8455 N MILLBROOK AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2152
Practice Address - Country:US
Practice Address - Phone:559-435-9505
Practice Address - Fax:559-435-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51602Medicare UPIN