Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5636 | CO |
N | 111N00000X | Chiropractor | CH7244 | FL |
NPI | 1003886433 |
---|---|
Provider Name | Dr. Russell Thyrl Swain III |
First Address | Colorado Springs, CO 80908-6000 |
Second Address | Colorado Springs, CO 80908-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70792 | (02) | CO |