=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780821561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GORDON W SWENSON D C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2009
-----------------------------------------------------
Last Update Date | 02/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3985 SWIFT RD
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34231-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-923-1533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3985 SWIFT RD
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34231-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-923-1533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | GORDON W SWENSON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 941-923-1533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------