Provider Demographics
NPI:1174849202
Name:EWERT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:EWERT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:EWERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-461-2013
Mailing Address - Street 1:620 N BALTIMORE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1600
Mailing Address - Country:US
Mailing Address - Phone:316-788-7500
Mailing Address - Fax:316-788-7702
Practice Address - Street 1:620 N BALTIMORE
Practice Address - Street 2:SUITE B
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1600
Practice Address - Country:US
Practice Address - Phone:316-788-7500
Practice Address - Fax:316-788-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty