Provider Demographics
NPI:1841373982
Name:SWENSON, MICHAEL R (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
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 1:28199 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-5845
Mailing Address - Country:US
Mailing Address - Phone:605-987-2829
Mailing Address - Fax:
Practice Address - Street 1:28199 WEST AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-5845
Practice Address - Country:US
Practice Address - Phone:605-987-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22445OtherSIOUX VALLEY HEALTH
4997728OtherWELLMARK
SD7601030Medicaid
80102Medicare ID - Type Unspecified
T66434Medicare UPIN