Provider Demographics
NPI:1851496889
Name:SWANN, MICHAEL SR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SWANN
Suffix:SR
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 1:800 AYRAULT RD STE 230
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8941
Mailing Address - Country:US
Mailing Address - Phone:585-223-7240
Mailing Address - Fax:585-223-9104
Practice Address - Street 1:800 AYRAULT RD STE 230
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8941
Practice Address - Country:US
Practice Address - Phone:585-223-7240
Practice Address - Fax:585-223-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009090-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7174331OtherAETNA
NYBB2009Medicare PIN
NYU71809Medicare UPIN