Provider Demographics
NPI:1255881181
Name:SWAIN, BRUCE
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:SWAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 FREEWAY BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1751
Mailing Address - Country:US
Mailing Address - Phone:763-441-8998
Mailing Address - Fax:763-441-7291
Practice Address - Street 1:2800 FREEWAY BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1751
Practice Address - Country:US
Practice Address - Phone:763-441-8998
Practice Address - Fax:763-441-7291
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor