Provider Demographics
NPI:1962677641
Name:SWENNY'S FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:SWENNY'S FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE-PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SWENNY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:217-825-8359
Mailing Address - Street 1:301 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1181
Mailing Address - Country:US
Mailing Address - Phone:217-825-8359
Mailing Address - Fax:217-562-2627
Practice Address - Street 1:301 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1181
Practice Address - Country:US
Practice Address - Phone:217-825-8359
Practice Address - Fax:217-562-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009553Medicaid