Provider Demographics
NPI:1043461973
Name:EWALD, AMY CHRISTINA (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CHRISTINA
Last Name:EWALD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5420
Mailing Address - Country:US
Mailing Address - Phone:651-338-2582
Mailing Address - Fax:
Practice Address - Street 1:361 N BENNETT ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4812
Practice Address - Country:US
Practice Address - Phone:910-692-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor