Healthcare Provider Details

I. General information

NPI: 1164480448
Provider Name (Legal Business Name): LAURA A. SWINGEN D.C., D.A.C.N.B.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11507 SW SHILO LN
PORTLAND OR
97225
US

IV. Provider business mailing address

11507 SW SHILO LN
PORTLAND OR
97225-5923
US

V. Phone/Fax

Practice location:
  • Phone: 503-643-2225
  • Fax: 503-520-0514
Mailing address:
  • Phone: 503-643-2225
  • Fax: 503-520-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27-2662
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number27-2662
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: