Healthcare Provider Details

I. General information

NPI: 1780670778
Provider Name (Legal Business Name): TIMOTHY JOSEPH SWINDLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12728 SE STARK ST BLDG G
PORTLAND OR
97233-1539
US

IV. Provider business mailing address

12728 SE STARK ST BLDG G
PORTLAND OR
97233-1539
US

V. Phone/Fax

Practice location:
  • Phone: 503-252-5097
  • Fax: 503-252-5297
Mailing address:
  • Phone: 503-252-5097
  • Fax: 503-252-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27-3387
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: