1407124795 NPI number — DR. KENNETH WARREN SWINFORD D.C.

Table of content: DR. KENNETH WARREN SWINFORD D.C. (NPI 1407124795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407124795 NPI number — DR. KENNETH WARREN SWINFORD D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWINFORD
Provider First Name:
KENNETH
Provider Middle Name:
WARREN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWINFORD
Provider Other First Name:
KENNETH
Provider Other Middle Name:
WARREN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407124795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18920 BOTHELL WAY NE
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-486-1122
Provider Business Mailing Address Fax Number:
425-487-6818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14090 FRYELANDS BLVD
Provider Second Line Business Practice Location Address:
#274
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-805-0112
Provider Business Practice Location Address Fax Number:
425-487-6818
Provider Enumeration Date:
12/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH60249597 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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