Provider Demographics
NPI:1811770225
Name:SWENSON, JARED SCOTT (DC)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:SCOTT
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 1:2397 GALENA DR APT 22
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6012
Mailing Address - Country:US
Mailing Address - Phone:224-542-0016
Mailing Address - Fax:
Practice Address - Street 1:11629 FOX RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8422
Practice Address - Country:US
Practice Address - Phone:224-542-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014023111N00000X
IN08003377A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor