Provider Demographics
NPI:1689733537
Name:SWACHA, BENJAMIN R (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:SWACHA
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 1:435 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-3208
Mailing Address - Country:US
Mailing Address - Phone:918-272-8054
Mailing Address - Fax:918-274-8044
Practice Address - Street 1:435 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3208
Practice Address - Country:US
Practice Address - Phone:918-272-8054
Practice Address - Fax:918-274-8044
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor