Provider Demographics
NPI:1558400754
Name:SWAN, DAVID (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SWAN
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 1:861 N DAVID CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1660
Mailing Address - Country:US
Mailing Address - Phone:480-961-2194
Mailing Address - Fax:
Practice Address - Street 1:1855 E GUADALUPE RD
Practice Address - Street 2:STE 112
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3273
Practice Address - Country:US
Practice Address - Phone:480-628-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5610111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ62816Medicare UPIN
AZ65493Medicare ID - Type Unspecified