Doctor Name: | DR. KEITH C SWAN |
NPI Number: | 1003885864 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 25822 |
Business Practice Address: | 2150 Pearl St Boulder, CO - 803024525 |
Business Phone Number: | 3034448337 |
Business Fax Number: | 3034448393 |
Mailing Address: | 1712 D St, BELLINGHAM |
State: | WA |
Postal Code: | 982253101 |
Phone Number: | 3607468827 |
Fax Number: | 3607468882 |
NPI Enumeration Date: | 03/15/2006 |
NPI Last Update Date: | 05/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | 25822 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |