Provider Demographics
NPI:1952509028
Name:SWAN, SANDRA (DC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 S EASTERN AVE
Mailing Address - Street 2:# 8
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3168
Mailing Address - Country:US
Mailing Address - Phone:702-796-1915
Mailing Address - Fax:702-796-6151
Practice Address - Street 1:6330 S EASTERN AVE
Practice Address - Street 2:#8
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3168
Practice Address - Country:US
Practice Address - Phone:702-796-1915
Practice Address - Fax:702-796-6151
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC602Medicare PIN
U58628Medicare UPIN