Provider Demographics
NPI:1013042308
Name:EWING, ROGER A (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:EWING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1207
Mailing Address - Country:US
Mailing Address - Phone:317-398-4404
Mailing Address - Fax:317-398-2225
Practice Address - Street 1:103 S TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1207
Practice Address - Country:US
Practice Address - Phone:317-398-4404
Practice Address - Fax:317-398-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000466A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100224280AMedicaid
IN4523198OtherAETNA
IN350045466OtherMEDICARE RAILROAD
IN000000209565OtherANTHEM BCBS
IN100224280AMedicaid
IN350045466OtherMEDICARE RAILROAD