Provider Demographics
NPI:1932375706
Name:LAURA A SWINGEN DC PC
Entity Type:Organization
Organization Name:LAURA A SWINGEN DC PC
Other - Org Name:SUNSET CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-643-2225
Mailing Address - Street 1:11507 SW SHILO LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5923
Mailing Address - Country:US
Mailing Address - Phone:503-643-2225
Mailing Address - Fax:503-520-0514
Practice Address - Street 1:11507 SW SHILO LN
Practice Address - Street 2:SUITE E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5923
Practice Address - Country:US
Practice Address - Phone:503-643-2225
Practice Address - Fax:503-520-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR000QGFPTMedicare UPIN
ORR0000QGFPTMedicare UPIN