MEDICARE: SANDRA SWAN DC

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	B602	NV

General Provider Information

NPI Number	:	1952509028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SWAN DC

Provider Business Mailing Address
First Line	:	6330 S EASTERN AVE
Second Line	:	# 8
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3168
Country	:	US
Telephone Number	:	702-796-1915
Fax Number	:	702-796-6151

Provider Business Practice Location Address
First Line	:	6330 S EASTERN AVE
Second Line	:	#8
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3168
Country	:	US
Telephone Number	:	702-796-1915
Fax Number	:	702-796-6151

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	09/14/2009

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Directions to “ SANDRA SWAN DC” Practice Location

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