Healthcare Provider Details

I. General information

NPI: 1063235661
Provider Name (Legal Business Name): BRANDON SWANTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11129 N WAUWATOSA RD
MEQUON WI
53097-3431
US

IV. Provider business mailing address

11129 N WAUWATOSA RD
MEQUON WI
53097-3431
US

V. Phone/Fax

Practice location:
  • Phone: 414-354-5377
  • Fax: 414-354-0523
Mailing address:
  • Phone: 414-354-5377
  • Fax: 414-354-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6239-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: