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General NPI Number Information
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NPI Number | 1528402674
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Entity Type | Individual
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Provider Name | CARLY SWIFT D.C.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 4640 SHORE DR STE 106 SAME
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-2859
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Country | US
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Telephone | 757-358-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 3809 JEFFERSON BLVD SAME
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-1605
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Country | US
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Telephone | 757-358-0700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 0104557053
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License Number State | VA
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