Provider Demographics
NPI:1194885657
Name:SWANSON, DAVID B (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:SWANSON
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 1:192 NEWPORT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-4110
Mailing Address - Country:US
Mailing Address - Phone:401-725-2264
Mailing Address - Fax:401-724-6360
Practice Address - Street 1:192 NEWPORT AVENUE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-4110
Practice Address - Country:US
Practice Address - Phone:401-725-2264
Practice Address - Fax:401-724-6360
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor