MEDICARE: J.C. SWINK CHIROPRACTIC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC24003	CA

General Provider Information

NPI Number	:	1326210337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.C. SWINK CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	31532 RAILROAD CANYON RD
Second Line	:	SUITE 112
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9437
Country	:	US
Telephone Number	:	951-764-9054
Fax Number	:

Provider Business Practice Location Address
First Line	:	31532 RAILROAD CANYON RD
Second Line	:	SUITE 112
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9437
Country	:	US
Telephone Number	:	951-764-9054
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFF C SWINK
Credential	:	D.C.
Telephone Number	:	951-764-9054

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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