MEDICARE: DR. RUSSELL THYRL SWAIN III D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5636	CO
2	111N00000X	Chiropractor	CH7244	FL

General Provider Information

NPI Number	:	1003886433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL THYRL SWAIN III D.C.

Provider Business Mailing Address
First Line	:	11590 BLACK FOREST RD
Second Line	:	SUITE 20
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-6000
Country	:	US
Telephone Number	:	719-494-0900
Fax Number	:	719-494-0901

Provider Business Practice Location Address
First Line	:	11590 BLACK FOREST RD
Second Line	:	SUITE 20
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-6000
Country	:	US
Telephone Number	:	719-494-0900
Fax Number	:	719-494-0901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/09/2007

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