Provider Demographics
NPI:1760459135
Name:EWELL, BRIAN HOWARD (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HOWARD
Last Name:EWELL
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 1:2964 WEST 4700 SOUTH
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84129-3301
Mailing Address - Country:US
Mailing Address - Phone:801-966-9100
Mailing Address - Fax:801-966-0094
Practice Address - Street 1:2964 WEST 4700 SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84129-3301
Practice Address - Country:US
Practice Address - Phone:801-966-9100
Practice Address - Fax:801-966-0094
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3446021202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU66829Medicare UPIN
UT00012359Medicare PIN