Provider Demographics
NPI:1164435277
Name:JOHN R. CHEWNING DO PA
Entity Type:Organization
Organization Name:JOHN R. CHEWNING DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:CHEWNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-256-3977
Mailing Address - Street 1:1425 HAND AVENUE, SUITE L
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-256-3977
Mailing Address - Fax:386-872-5004
Practice Address - Street 1:1425 HAND AVE, SUITE L
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-256-3977
Practice Address - Fax:386-872-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0008Medicare PIN
FLI57825Medicare UPIN