Provider Demographics
NPI:1518919125
Name:EWING, MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:EWING
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 1:2611 FOREST AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4384
Mailing Address - Country:US
Mailing Address - Phone:530-899-9988
Mailing Address - Fax:530-899-8598
Practice Address - Street 1:2611 FOREST AVE
Practice Address - Street 2:STE 100
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4384
Practice Address - Country:US
Practice Address - Phone:530-899-9988
Practice Address - Fax:530-899-8598
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU74146Medicare UPIN