Provider Demographics
NPI:1457381311
Name:SWENNY, RONALD PAUL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:SWENNY
Suffix:JR
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 1:301 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:214-825-8359
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:214-825-8359
Practice Address - Fax:217-562-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008432081OtherBLUE CROSS/ BLUE SHIELD
IL201756Medicare ID - Type Unspecified
ILU90115Medicare UPIN