Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH00034667 | WA |
NPI | 1003960691 |
---|---|
Provider Name | Dr. Justin Matthew Swanson |
First Address | Seattle, WA 98116-3771 |
Second Address | Seattle, WA 98116-3771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 17/06/2009 |