Provider Demographics
NPI:1689947327
Name:SWAIM CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SWAIM CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-466-4580
Mailing Address - Street 1:1314 12TH AVE S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4646
Mailing Address - Country:US
Mailing Address - Phone:208-466-4580
Mailing Address - Fax:208-685-2881
Practice Address - Street 1:1314 12TH AVE S
Practice Address - Street 2:SUITE 1
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4646
Practice Address - Country:US
Practice Address - Phone:208-466-4580
Practice Address - Fax:208-685-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1700824265Medicaid
ID1700824265Medicaid