Provider Demographics
NPI:1114946993
Name:EWING, SCOTT E (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
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 1:705 JOHN SIMS PKWY W
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1878
Mailing Address - Country:US
Mailing Address - Phone:850-678-8048
Mailing Address - Fax:850-678-2629
Practice Address - Street 1:705 JOHN SIMS PKWY W
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1878
Practice Address - Country:US
Practice Address - Phone:850-678-8048
Practice Address - Fax:850-678-2629
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55426OtherBLUE CROSS BLUE SHILED
FLP00022029OtherRAILROAD MEDICARE
FLU61444Medicare UPIN
FL55426ZMedicare ID - Type Unspecified