Healthcare Provider Details

I. General information

NPI: 1639352024
Provider Name (Legal Business Name): JOHN R. SWENSON DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2007
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2287 ROCKING HORSE CT
COLORADO SPRINGS CO
80921-6401
US

IV. Provider business mailing address

2287 ROCKING HORSE CT
COLORADO SPRINGS CO
80921-6401
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-6677
  • Fax: 719-473-9219
Mailing address:
  • Phone: 719-473-6677
  • Fax: 719-473-9219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number474
License Number StateCO

VIII. Authorized Official

Name: DR. JOHN ROBERT SWENSON
Title or Position: SOLE PROPRIETOR
Credential: DPM
Phone: 719-473-6677