Provider Demographics
NPI:1770956112
Name:SWINDLE, DARRYL
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:SWINDLE
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 1:1430 E 69TH ST
Mailing Address - Street 2:UNIT 3S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-4887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1430 E 69TH ST
Practice Address - Street 2:UNIT 3S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-4887
Practice Address - Country:US
Practice Address - Phone:312-459-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)