Provider Demographics
NPI:1457621161
Name:SWEDBERG, JAY WARNER (MSTCM DIPL OM)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:WARNER
Last Name:SWEDBERG
Suffix:
Gender:M
Credentials:MSTCM DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19555 E PARKER SQUARE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7307
Mailing Address - Country:US
Mailing Address - Phone:720-341-0246
Mailing Address - Fax:
Practice Address - Street 1:11751 N TOMAHAWK RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8120
Practice Address - Country:US
Practice Address - Phone:720-341-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1360171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist