Provider Demographics
NPI:1710529417
Name:SWANGLER, JOHN JAMES
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:SWANGLER
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 1:5346 S COUNTY ROAD 405
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868-8028
Mailing Address - Country:US
Mailing Address - Phone:205-767-5064
Mailing Address - Fax:
Practice Address - Street 1:3202 MARK TWAIN DR
Practice Address - Street 2:
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935-8619
Practice Address - Country:US
Practice Address - Phone:205-767-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2023-11-27
Deactivation Date:2022-10-21
Deactivation Code:
Reactivation Date:2023-11-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
021309OtherOTHER PAY FOR SERVICE