MEDICARE: DR. TIMOTHY JOSEPH SWINDLER D.C.

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	27-3387	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75 3115541	OTHER	OR	TAX ID
2	823823000	OTHER	OR	BLUECROSS BLUE SHEILD

General Provider Information

NPI Number	:	1780670778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JOSEPH SWINDLER D.C.

Provider Business Mailing Address
First Line	:	12728 SE STARK ST BLDG G
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97233-1539
Country	:	US
Telephone Number	:	503-252-5097
Fax Number	:	503-252-5297

Provider Business Practice Location Address
First Line	:	12728 SE STARK ST BLDG G
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97233-1539
Country	:	US
Telephone Number	:	503-252-5097
Fax Number	:	503-252-5297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2005
Last Update Date	:	12/18/2008

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