Healthcare Provider Details

I. General information

NPI: 1356574495
Provider Name (Legal Business Name): JANINE MARIE SWENBERG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ETON WAY
MILL VALLEY CA
94941-1414
US

IV. Provider business mailing address

PO BOX 390862
KEAUHOU HI
96739-0862
US

V. Phone/Fax

Practice location:
  • Phone: 415-302-4717
  • Fax:
Mailing address:
  • Phone: 415-302-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: