Provider Demographics
NPI:1922072388
Name:SWIFT, JEFFREY GERALD (DC DABCN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GERALD
Last Name:SWIFT
Suffix:
Gender:M
Credentials:DC DABCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FAIRHAVEN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739
Mailing Address - Country:US
Mailing Address - Phone:508-758-3666
Mailing Address - Fax:508-758-3289
Practice Address - Street 1:109 FAIRHAVEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739
Practice Address - Country:US
Practice Address - Phone:508-758-3666
Practice Address - Fax:508-758-3289
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1608118Medicaid
MA1218OtherCHIROPRACTIC LICENSE
MA1608118Medicaid