Provider Demographics
NPI:1568514651
Name:SWAN, STUART EDWARD
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:EDWARD
Last Name:SWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1617
Mailing Address - Country:US
Mailing Address - Phone:810-516-8904
Mailing Address - Fax:
Practice Address - Street 1:211 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1617
Practice Address - Country:US
Practice Address - Phone:810-658-7926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor