Individual
SHAD LEROY SWANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
403 AMERICA AVE NW, BEMIDJI, MN 56601-3122
(218) 444-8727
(218) 444-8546
Mailing address
3807 VALLEY VIEW DR NE, BEMIDJI, MN 56601-4754
(218) 751-2150
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4040
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122393300
—
MN
01
—
219G4SW
BLUE CROSS BLUE SHIELD
MN
Enumeration date
07/07/2005
Last updated
12/04/2007
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