Provider Demographics
NPI:1043497084
Name:MCEWEN CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:MCEWEN CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-985-9390
Mailing Address - Street 1:2386 CLOWER ST
Mailing Address - Street 2:SUITE G/102
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6134
Mailing Address - Country:US
Mailing Address - Phone:770-985-9390
Mailing Address - Fax:770-985-7366
Practice Address - Street 1:2386 CLOWER ST
Practice Address - Street 2:SUITE G/102
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6134
Practice Address - Country:US
Practice Address - Phone:770-985-9390
Practice Address - Fax:770-985-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO01846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22348Medicare UPIN