Provider Demographics
NPI:1649059247
Name:SWANSON, DODGEN NATHANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:DODGEN
Middle Name:NATHANIEL
Last Name:SWANSON
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 1:1740 N GERMANTOWN PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3308
Mailing Address - Country:US
Mailing Address - Phone:901-296-3386
Mailing Address - Fax:
Practice Address - Street 1:1740 N GERMANTOWN PKWY STE 6
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-3308
Practice Address - Country:US
Practice Address - Phone:901-296-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty