Provider Demographics
NPI:1205942695
Name:EWING, JOSEPH TODD (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TODD
Last Name:EWING
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:PO BOX 751176
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-1176
Mailing Address - Country:US
Mailing Address - Phone:937-435-5566
Mailing Address - Fax:
Practice Address - Street 1:7625 PARAGON RD
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4067
Practice Address - Country:US
Practice Address - Phone:937-435-5566
Practice Address - Fax:937-425-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U17371Medicare UPIN