Provider Demographics
NPI:1912072703
Name:SWAIN, MATTHEW CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHARLES
Last Name:SWAIN
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 1:3257 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2909
Mailing Address - Country:US
Mailing Address - Phone:810-664-8404
Mailing Address - Fax:
Practice Address - Street 1:3257 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2909
Practice Address - Country:US
Practice Address - Phone:810-664-8404
Practice Address - Fax:810-664-8404
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1823710Medicaid
MI0D41160OtherBCBSM
MI0D45006Medicare ID - Type UnspecifiedMEDICARE NUMBER