MEDICARE: DR. RONALD PAUL SWENNY JR. 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0008432081	OTHER	IL	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1457381311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD PAUL SWENNY JR. D.C.

Provider Business Mailing Address
First Line	:	301 N WALNUT ST
Second Line	:
City	:	PANA
State	:	IL
Zip	:	62557-1181
Country	:	US
Telephone Number	:	214-825-8359
Fax Number	:	217-562-2627

Provider Business Practice Location Address
First Line	:	301 N WALNUT ST
Second Line	:
City	:	PANA
State	:	IL
Zip	:	62557-1181
Country	:	US
Telephone Number	:	214-825-8359
Fax Number	:	217-562-2627

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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