Provider Demographics
NPI:1265532238
Name:SWENSON, DENNIS CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CHARLES
Last Name:SWENSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SUNRISE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4123
Mailing Address - Country:US
Mailing Address - Phone:916-780-9017
Mailing Address - Fax:916-780-9019
Practice Address - Street 1:408 SUNRISE AVE
Practice Address - Street 2:STE 4
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4123
Practice Address - Country:US
Practice Address - Phone:916-780-9017
Practice Address - Fax:916-780-9019
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0138851Medicare ID - Type Unspecified