Provider Demographics
NPI:1619047438
Name:SWIM, TINA F
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:F
Last Name:SWIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 LAKE MURRAY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-466-7633
Mailing Address - Fax:619-466-5545
Practice Address - Street 1:5465 LAKE MURRAY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-466-7633
Practice Address - Fax:619-466-5545
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC20812Medicare PIN