Provider Demographics
NPI:1013206192
Name:SWENSON CHIROPRACTIC SC
Entity Type:Organization
Organization Name:SWENSON CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-735-3160
Mailing Address - Street 1:720 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1725
Mailing Address - Country:US
Mailing Address - Phone:815-735-3160
Mailing Address - Fax:
Practice Address - Street 1:54 W COUNTRYSIDE PKWY STE D
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1965
Practice Address - Country:US
Practice Address - Phone:630-592-1286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty