Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 25822 | CO |
NPI | 1003885864 |
---|---|
Provider Name | Dr. Keith C Swan |
First Address | Bellingham, WA 98225-3101 |
Second Address | Boulder, CO 80302-4525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 11/05/2016 |