Healthcare Provider Details

I. General information

NPI: 1235487109
Provider Name (Legal Business Name): JASON STUART SWAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2012
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E SOUTH ST
DAVISON MI
48423-1617
US

IV. Provider business mailing address

211 E SOUTH ST
DAVISON MI
48423-1617
US

V. Phone/Fax

Practice location:
  • Phone: 810-658-7926
  • Fax: 810-653-4186
Mailing address:
  • Phone: 810-658-7926
  • Fax: 810-653-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010037
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: