Provider Demographics
NPI:1871856070
Name:SWELLA CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:SWELLA CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SWELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:760-365-1933
Mailing Address - Street 1:56994 29 PALMS HWY
Mailing Address - Street 2:STE C
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56994 29 PALMS HWY
Practice Address - Street 2:STE C
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2946
Practice Address - Country:US
Practice Address - Phone:760-365-1933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty