Healthcare Provider Details

I. General information

NPI: 1790856227
Provider Name (Legal Business Name): SWAN CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 42ND STREET
JASPER IN
47546-8222
US

IV. Provider business mailing address

201 42ND STREET
JASPER IN
47546-8222
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-4900
  • Fax:
Mailing address:
  • Phone: 812-482-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002122A
License Number StateIN

VIII. Authorized Official

Name: DR. CHARLES M SWAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 812-482-4900