Provider Demographics
NPI:1982864484
Name:EWING CHIROPRACTIC FAMILY CLINIC INC PC
Entity Type:Organization
Organization Name:EWING CHIROPRACTIC FAMILY CLINIC INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-398-4404
Mailing Address - Street 1:103 S TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1207
Mailing Address - Country:US
Mailing Address - Phone:317-398-4404
Mailing Address - Fax:317-398-2225
Practice Address - Street 1:103 S TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1207
Practice Address - Country:US
Practice Address - Phone:317-398-4404
Practice Address - Fax:317-398-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN740940Medicare PIN