Provider Demographics
NPI:1356376594
Name:SEWELL, PHILIP J (DC)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:J
Last Name:SEWELL
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 455
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-0455
Mailing Address - Country:US
Mailing Address - Phone:812-295-2387
Mailing Address - Fax:812-295-5850
Practice Address - Street 1:1102 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-0455
Practice Address - Country:US
Practice Address - Phone:812-295-2387
Practice Address - Fax:812-295-5850
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100242720Medicaid
T35077Medicare UPIN
IN100242720Medicaid