Provider Demographics
NPI:1154394815
Name:SWENSON, RYAN V (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:V
Last Name:SWENSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2902
Mailing Address - Country:US
Mailing Address - Phone:605-342-3908
Mailing Address - Fax:605-342-0250
Practice Address - Street 1:610 EAST BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2902
Practice Address - Country:US
Practice Address - Phone:605-342-3908
Practice Address - Fax:605-342-0250
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7602480Medicaid
SD7602480Medicaid
S100296Medicare PIN