=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679852149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWAIN CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2011
-----------------------------------------------------
Last Update Date | 12/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 931 ORANGEBURG RD.
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-900-7006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 931 ORANGEBURG RD.
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-900-7006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RONALD SWAIN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 843-900-7006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC.3611
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------