Provider Demographics
NPI:1740407758
Name:SWIFT, TIMOTHY GLENCROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GLENCROSS
Last Name:SWIFT
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 1:3551 CAMINO MIRA COSTA
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672
Mailing Address - Country:US
Mailing Address - Phone:949-751-4000
Mailing Address - Fax:949-751-4004
Practice Address - Street 1:3551 CAMINO MIRA COSTA
Practice Address - Street 2:SUITE A
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672
Practice Address - Country:US
Practice Address - Phone:949-751-4000
Practice Address - Fax:949-751-4004
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor